| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
838 |
796 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
634 |
609 |
$9K |
| D0274 |
Bitewings - four radiographic images |
355 |
349 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
150 |
145 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
12 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
125 |
119 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
260 |
244 |
$2K |
| D0330 |
Panoramic radiographic image |
42 |
42 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
15 |
$2K |