| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,404 |
3,377 |
$286K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,533 |
1,648 |
$189K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,471 |
2,456 |
$159K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,689 |
1,399 |
$151K |
| D0120 |
Periodic oral evaluation - established patient |
2,302 |
2,281 |
$137K |
| D2330 |
|
1,207 |
638 |
$92K |
| D0330 |
Panoramic radiographic image |
1,635 |
1,624 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
556 |
427 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
3,024 |
2,861 |
$36K |
| D4341 |
|
403 |
134 |
$28K |
| D0350 |
|
3,928 |
2,221 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
539 |
537 |
$25K |
| D1120 |
Prophylaxis - child |
500 |
499 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,272 |
1,982 |
$13K |
| D0274 |
Bitewings - four radiographic images |
365 |
363 |
$7K |
| D1205 |
|
40 |
40 |
$0.00 |