| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
256 |
224 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
102 |
25 |
$8K |
| D1110 |
Prophylaxis - adult |
155 |
124 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
13 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
172 |
148 |
$3K |
| D0274 |
Bitewings - four radiographic images |
53 |
51 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
62 |
47 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
30 |
30 |
$745.20 |