| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,558 |
3,545 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
4,203 |
4,175 |
$107K |
| D0274 |
Bitewings - four radiographic images |
3,340 |
3,322 |
$84K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
258 |
167 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
174 |
137 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,156 |
1,148 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
785 |
783 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
177 |
177 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
30 |
$2K |
| D9920 |
|
13 |
13 |
$203.00 |
| D9110 |
|
12 |
12 |
$184.04 |
| 00120 |
|
62 |
62 |
$0.00 |