| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
419 |
379 |
$10K |
| D1110 |
Prophylaxis - adult |
262 |
234 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
92 |
55 |
$5K |
| D0274 |
Bitewings - four radiographic images |
265 |
245 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
52 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
150 |
138 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
27 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
138 |
128 |
$2K |
| D0330 |
Panoramic radiographic image |
48 |
44 |
$2K |
| D1120 |
Prophylaxis - child |
64 |
61 |
$1K |
| D1206 |
Topical application of fluoride varnish |
64 |
62 |
$906.00 |
| D0220 |
Intraoral - periapical first radiographic image |
84 |
80 |
$385.75 |