| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
892 |
864 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,094 |
1,058 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
741 |
714 |
$11K |
| D0330 |
Panoramic radiographic image |
328 |
305 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
42 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
613 |
597 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
584 |
554 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
158 |
152 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
735 |
695 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
12 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
98 |
39 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
432 |
239 |
$1K |