| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
8,732 |
2,550 |
$86K |
| D1110 |
Prophylaxis - adult |
1,963 |
1,789 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,391 |
393 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,329 |
1,167 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,688 |
1,561 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,568 |
1,432 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,092 |
2,758 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
103 |
61 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
130 |
$5K |
| D4355 |
|
61 |
57 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D2140 |
|
32 |
16 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
23 |
22 |
$771.12 |