| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
840 |
765 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,295 |
1,168 |
$33K |
| D0274 |
Bitewings - four radiographic images |
941 |
840 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
269 |
260 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
688 |
368 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
40 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
393 |
378 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
205 |
193 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,732 |
1,525 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,244 |
824 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
97 |
27 |
$1K |
| D1999 |
|
1,557 |
1,274 |
$0.00 |