| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,424 |
1,396 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
1,145 |
1,128 |
$35K |
| D0274 |
Bitewings - four radiographic images |
923 |
896 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
981 |
895 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
213 |
190 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
70 |
$12K |
| D0330 |
Panoramic radiographic image |
193 |
172 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
20 |
12 |
$540.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
872 |
854 |
$0.00 |
| D0431 |
|
479 |
462 |
$0.00 |