| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
592 |
316 |
$12K |
| D1120 |
Prophylaxis - child |
492 |
241 |
$7K |
| D0330 |
Panoramic radiographic image |
405 |
190 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
95 |
39 |
$5K |
| D1206 |
Topical application of fluoride varnish |
408 |
193 |
$4K |
| D0274 |
Bitewings - four radiographic images |
370 |
175 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
76 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
13 |
$3K |
| D0350 |
|
356 |
120 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
45 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
106 |
85 |
$983.31 |