| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,045 |
1,960 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,532 |
2,425 |
$63K |
| D0274 |
Bitewings - four radiographic images |
904 |
848 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
309 |
137 |
$18K |
| D0330 |
Panoramic radiographic image |
296 |
280 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
119 |
96 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
779 |
733 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
696 |
541 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
473 |
451 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
187 |
172 |
$6K |
| D1120 |
Prophylaxis - child |
100 |
96 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
58 |
57 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$891.60 |