| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,040 |
876 |
$36K |
| D0330 |
Panoramic radiographic image |
451 |
366 |
$16K |
| D1120 |
Prophylaxis - child |
561 |
474 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
469 |
383 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
547 |
474 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
345 |
311 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
43 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
74 |
56 |
$2K |
| D1206 |
Topical application of fluoride varnish |
33 |
33 |
$737.80 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$471.30 |
| D0230 |
Intraoral - periapical each additional radiographic image |
32 |
12 |
$207.45 |