| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
655 |
624 |
$32K |
| D1120 |
Prophylaxis - child |
712 |
654 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
202 |
113 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
180 |
58 |
$16K |
| D1330 |
|
1,018 |
940 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
431 |
388 |
$11K |
| D1110 |
Prophylaxis - adult |
352 |
335 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
472 |
421 |
$9K |
| D1206 |
Topical application of fluoride varnish |
761 |
701 |
$8K |
| D0274 |
Bitewings - four radiographic images |
263 |
254 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
539 |
358 |
$4K |
| D1320 |
|
124 |
118 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
52 |
51 |
$750.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
70 |
26 |
$442.00 |