| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,468 |
2,907 |
$163K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
688 |
379 |
$139K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
596 |
349 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,565 |
2,106 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
1,702 |
1,346 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
1,436 |
1,255 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,102 |
965 |
$45K |
| D0330 |
Panoramic radiographic image |
569 |
521 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
268 |
109 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
150 |
129 |
$6K |
| D1120 |
Prophylaxis - child |
25 |
25 |
$1K |
| D1999 |
|
16 |
14 |
$0.00 |
| D0601 |
|
24 |
24 |
$0.00 |