| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
554 |
489 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
453 |
417 |
$15K |
| D0330 |
Panoramic radiographic image |
115 |
106 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
77 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
256 |
209 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
139 |
117 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
247 |
232 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
25 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
56 |
52 |
$1K |
| D4355 |
|
29 |
21 |
$1K |