| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,305 |
1,295 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,380 |
1,370 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
678 |
320 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
1,916 |
1,874 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
655 |
633 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
586 |
580 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
968 |
963 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,390 |
1,352 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
271 |
140 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
204 |
128 |
$14K |
| D0330 |
Panoramic radiographic image |
336 |
336 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
86 |
59 |
$12K |
| D1120 |
Prophylaxis - child |
71 |
70 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
78 |
77 |
$2K |