| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
414 |
403 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
174 |
152 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
107 |
96 |
$9K |
| D0274 |
Bitewings - four radiographic images |
368 |
361 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
407 |
397 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
154 |
151 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
68 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
192 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
44 |
$3K |
| D1320 |
|
161 |
158 |
$2K |
| D1330 |
|
404 |
393 |
$2K |
| D1310 |
|
401 |
391 |
$2K |
| D2332 |
|
14 |
14 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
122 |
121 |
$841.20 |
| D0140 |
Limited oral evaluation - problem focused |
41 |
41 |
$704.40 |