| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,605 |
2,419 |
$65K |
| D1110 |
Prophylaxis - adult |
1,778 |
1,708 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,708 |
1,638 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
2,160 |
2,078 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
1,837 |
1,695 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
257 |
156 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,512 |
809 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
66 |
$6K |
| D5640 |
|
24 |
13 |
$1K |
| D1120 |
Prophylaxis - child |
28 |
28 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
13 |
$987.24 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$630.24 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$341.04 |