| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
842 |
804 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
193 |
124 |
$18K |
| D1110 |
Prophylaxis - adult |
201 |
193 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
24 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
115 |
110 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
505 |
476 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
39 |
$3K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$418.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
17 |
$306.00 |
| D9986 |
|
13 |
12 |
$0.00 |