| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
2,654 |
2,632 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
516 |
484 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
1,694 |
1,680 |
$14K |
| D1110 |
Prophylaxis - adult |
404 |
404 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
422 |
422 |
$7K |
| D0270 |
|
421 |
419 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
117 |
117 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
137 |
137 |
$2K |
| D1120 |
Prophylaxis - child |
69 |
69 |
$2K |
| D0274 |
Bitewings - four radiographic images |
100 |
100 |
$2K |
| D9310 |
|
30 |
30 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
277 |
275 |
$1K |
| D9996 |
|
86 |
83 |
$678.24 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$288.30 |