| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
806 |
767 |
$30K |
| D0330 |
Panoramic radiographic image |
582 |
559 |
$11K |
| D0274 |
Bitewings - four radiographic images |
542 |
520 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
273 |
261 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
474 |
453 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
185 |
175 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
282 |
139 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
24 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
26 |
$868.43 |
| D0220 |
Intraoral - periapical first radiographic image |
264 |
251 |
$749.06 |
| D9215 |
|
652 |
573 |
$0.00 |