| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
174 |
159 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
256 |
240 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
198 |
176 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
55 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
392 |
355 |
$2K |
| D0274 |
Bitewings - four radiographic images |
117 |
109 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
70 |
60 |
$2K |
| D1110 |
Prophylaxis - adult |
30 |
30 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
48 |
47 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
14 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
241 |
210 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
48 |
44 |
$712.80 |