| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,916 |
2,871 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,174 |
2,145 |
$46K |
| D0272 |
Bitewings - two radiographic images |
3,099 |
3,050 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
818 |
481 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
520 |
358 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,252 |
1,214 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,506 |
1,483 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
536 |
429 |
$20K |
| D1120 |
Prophylaxis - child |
410 |
405 |
$9K |
| D0330 |
Panoramic radiographic image |
187 |
186 |
$7K |
| D2140 |
|
75 |
52 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
13 |
$1K |
| D2331 |
|
21 |
13 |
$964.68 |
| D2332 |
|
19 |
13 |
$932.40 |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
41 |
$288.50 |