| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,981 |
2,496 |
$106K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,119 |
525 |
$72K |
| D1120 |
Prophylaxis - child |
2,876 |
2,346 |
$67K |
| D0330 |
Panoramic radiographic image |
1,398 |
1,140 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,805 |
2,262 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
277 |
157 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
990 |
669 |
$23K |
| D0272 |
Bitewings - two radiographic images |
973 |
727 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
262 |
181 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
13 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
86 |
72 |
$2K |
| D1351 |
Sealant - per tooth |
178 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
18 |
18 |
$430.80 |
| D1110 |
Prophylaxis - adult |
71 |
12 |
$195.00 |