| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,106 |
1,031 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
402 |
118 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,027 |
1,006 |
$18K |
| D0274 |
Bitewings - four radiographic images |
758 |
732 |
$15K |
| D1110 |
Prophylaxis - adult |
419 |
412 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
929 |
906 |
$13K |
| D1120 |
Prophylaxis - child |
596 |
580 |
$12K |
| D0330 |
Panoramic radiographic image |
148 |
140 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
197 |
188 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,002 |
937 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
659 |
204 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
27 |
25 |
$273.00 |