| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,478 |
2,475 |
$82K |
| D5110 |
|
114 |
112 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,727 |
1,720 |
$44K |
| D0330 |
Panoramic radiographic image |
1,246 |
1,243 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,955 |
1,948 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
564 |
376 |
$32K |
| D5120 |
|
63 |
61 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,387 |
1,386 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,270 |
2,227 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,492 |
1,358 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
235 |
171 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
191 |
84 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
178 |
122 |
$8K |
| D2332 |
|
115 |
74 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
168 |
168 |
$7K |
| D9110 |
|
92 |
90 |
$3K |
| D2335 |
|
20 |
14 |
$1K |
| D2331 |
|
15 |
12 |
$843.00 |
| D0140 |
Limited oral evaluation - problem focused |
541 |
531 |
$0.00 |
| D0367 |
|
201 |
201 |
$0.00 |