| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,778 |
1,628 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
832 |
389 |
$54K |
| D1110 |
Prophylaxis - adult |
1,192 |
1,172 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,213 |
1,200 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,073 |
1,034 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
51 |
$14K |
| D0330 |
Panoramic radiographic image |
169 |
161 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
354 |
348 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
118 |
115 |
$5K |
| D0272 |
Bitewings - two radiographic images |
194 |
189 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
139 |
65 |
$2K |