| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
734 |
733 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
581 |
580 |
$15K |
| D0274 |
Bitewings - four radiographic images |
594 |
592 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
337 |
336 |
$9K |
| D0330 |
Panoramic radiographic image |
312 |
311 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
27 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
239 |
234 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
79 |
$1K |
| D1999 |
|
180 |
163 |
$0.00 |