| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,590 |
1,476 |
$57K |
| D1110 |
Prophylaxis - adult |
1,302 |
1,217 |
$56K |
| D0274 |
Bitewings - four radiographic images |
884 |
823 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
416 |
137 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
698 |
627 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,122 |
1,048 |
$22K |
| D0330 |
Panoramic radiographic image |
226 |
208 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
193 |
103 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
498 |
437 |
$6K |
| D1120 |
Prophylaxis - child |
227 |
210 |
$4K |
| D0272 |
Bitewings - two radiographic images |
181 |
176 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
105 |
$783.65 |