| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
724 |
719 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
241 |
115 |
$17K |
| D1110 |
Prophylaxis - adult |
381 |
379 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
263 |
89 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
723 |
719 |
$13K |
| D0274 |
Bitewings - four radiographic images |
374 |
371 |
$11K |
| D1120 |
Prophylaxis - child |
262 |
260 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
266 |
259 |
$7K |
| D0330 |
Panoramic radiographic image |
121 |
120 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
29 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
318 |
311 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
52 |
51 |
$1K |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$260.84 |