| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
230 |
230 |
$8K |
| D1110 |
Prophylaxis - adult |
110 |
110 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
61 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
15 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
50 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$875.49 |
| D0274 |
Bitewings - four radiographic images |
15 |
15 |
$440.41 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$158.91 |