| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
272 |
268 |
$7K |
| D1110 |
Prophylaxis - adult |
177 |
175 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
238 |
236 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
65 |
65 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
31 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
12 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
27 |
$3K |
| D0274 |
Bitewings - four radiographic images |
132 |
130 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
104 |
103 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
59 |
56 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
14 |
$1K |
| D1120 |
Prophylaxis - child |
53 |
52 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
26 |
$140.00 |