| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
258 |
211 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
608 |
502 |
$1K |
| D1120 |
Prophylaxis - child |
114 |
106 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
264 |
236 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
50 |
48 |
$821.86 |
| D0120 |
Periodic oral evaluation - established patient |
216 |
189 |
$762.09 |
| D0274 |
Bitewings - four radiographic images |
122 |
116 |
$721.44 |
| D1110 |
Prophylaxis - adult |
80 |
73 |
$699.09 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
14 |
$489.06 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
12 |
$359.04 |
| D0230 |
Intraoral - periapical each additional radiographic image |
100 |
93 |
$294.97 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
14 |
$204.55 |