| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
965 |
937 |
$38K |
| D1120 |
Prophylaxis - child |
1,007 |
978 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
738 |
577 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,016 |
984 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
88 |
43 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
43 |
$8K |
| D0330 |
Panoramic radiographic image |
74 |
74 |
$3K |
| D0272 |
Bitewings - two radiographic images |
105 |
102 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
12 |
$2K |
| D0350 |
|
78 |
75 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
139 |
130 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$360.92 |
| D1999 |
|
348 |
276 |
$0.00 |