| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
369 |
363 |
$11K |
| D1110 |
Prophylaxis - adult |
181 |
179 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
39 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
34 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
75 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
134 |
122 |
$4K |
| D0274 |
Bitewings - four radiographic images |
153 |
144 |
$4K |
| D0330 |
Panoramic radiographic image |
68 |
68 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
16 |
$3K |
| D1206 |
Topical application of fluoride varnish |
91 |
83 |
$3K |
| D1120 |
Prophylaxis - child |
55 |
47 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
33 |
$1K |
| D0603 |
|
14 |
13 |
$0.00 |