| Code | Description | Claims | Beneficiaries | Total Paid |
| D0140 |
Limited oral evaluation - problem focused |
4,265 |
2,831 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,828 |
2,044 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
4,699 |
3,383 |
$38K |
| D0330 |
Panoramic radiographic image |
1,799 |
1,307 |
$36K |
| D4355 |
|
697 |
493 |
$28K |
| D1120 |
Prophylaxis - child |
621 |
443 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
785 |
323 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,137 |
2,258 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
194 |
172 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
622 |
457 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
92 |
46 |
$4K |
| D8660 |
|
80 |
80 |
$4K |
| D0340 |
|
54 |
47 |
$2K |
| D0350 |
|
104 |
80 |
$2K |
| D1110 |
Prophylaxis - adult |
24 |
24 |
$945.00 |
| D0120 |
Periodic oral evaluation - established patient |
43 |
41 |
$888.75 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
12 |
$731.85 |
| D1330 |
|
90 |
82 |
$0.00 |
| D1310 |
|
33 |
26 |
$0.00 |