| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
351 |
339 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
171 |
132 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
179 |
112 |
$17K |
| D0330 |
Panoramic radiographic image |
192 |
188 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
41 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
15 |
$2K |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$213.70 |
| D0999 |
Unspecified diagnostic procedure, by report |
26 |
22 |
$210.54 |
| D1206 |
Topical application of fluoride varnish |
23 |
19 |
$0.00 |