| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,221 |
770 |
$32K |
| D0330 |
Panoramic radiographic image |
415 |
339 |
$15K |
| D1120 |
Prophylaxis - child |
622 |
485 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
425 |
319 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
126 |
54 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
40 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
462 |
344 |
$6K |
| D0274 |
Bitewings - four radiographic images |
81 |
73 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
50 |
45 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
150 |
83 |
$929.54 |