| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,222 |
1,214 |
$42K |
| D4346 |
|
359 |
359 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
563 |
375 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
592 |
589 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
314 |
173 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
335 |
219 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
458 |
454 |
$13K |
| D0274 |
Bitewings - four radiographic images |
414 |
411 |
$12K |
| D1110 |
Prophylaxis - adult |
232 |
231 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
587 |
576 |
$7K |
| D9110 |
|
30 |
30 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
50 |
50 |
$905.43 |