| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,588 |
1,564 |
$84K |
| D0330 |
Panoramic radiographic image |
678 |
665 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,443 |
1,422 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,203 |
1,187 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,511 |
1,406 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
238 |
111 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
147 |
83 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
177 |
175 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
186 |
146 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
14 |
$980.00 |
| D0140 |
Limited oral evaluation - problem focused |
21 |
21 |
$840.00 |