| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,538 |
1,506 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,940 |
1,902 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
598 |
312 |
$37K |
| D1120 |
Prophylaxis - child |
586 |
578 |
$25K |
| D0330 |
Panoramic radiographic image |
738 |
720 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,043 |
1,024 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
579 |
568 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
242 |
236 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
499 |
471 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
44 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
95 |
95 |
$2K |
| D0272 |
Bitewings - two radiographic images |
51 |
49 |
$538.05 |