| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
256 |
204 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
203 |
$9K |
| D1120 |
Prophylaxis - child |
239 |
222 |
$7K |
| D1206 |
Topical application of fluoride varnish |
208 |
195 |
$5K |
| D0330 |
Panoramic radiographic image |
118 |
103 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
19 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
15 |
$2K |
| D0272 |
Bitewings - two radiographic images |
33 |
29 |
$470.03 |
| D0220 |
Intraoral - periapical first radiographic image |
31 |
18 |
$212.38 |