| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,359 |
1,161 |
$49K |
| D1110 |
Prophylaxis - adult |
550 |
545 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
171 |
74 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
815 |
813 |
$19K |
| D4355 |
|
233 |
231 |
$19K |
| D0330 |
Panoramic radiographic image |
252 |
252 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
69 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
67 |
40 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
528 |
494 |
$9K |
| D0272 |
Bitewings - two radiographic images |
288 |
278 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
91 |
86 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
122 |
121 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
308 |
110 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$408.00 |