| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
4,124 |
1,801 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,321 |
1,271 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,502 |
1,440 |
$34K |
| D1110 |
Prophylaxis - adult |
954 |
905 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,200 |
2,090 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
781 |
735 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
920 |
884 |
$19K |
| D1120 |
Prophylaxis - child |
244 |
238 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
26 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
12 |
$1K |
| D2140 |
|
27 |
14 |
$1K |