| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,039 |
965 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,447 |
1,342 |
$63K |
| D0330 |
Panoramic radiographic image |
224 |
213 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
851 |
739 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
927 |
344 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
41 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
168 |
147 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
285 |
259 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
63 |
46 |
$2K |
| D4910 |
|
12 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
210 |
185 |
$1K |
| D0272 |
Bitewings - two radiographic images |
39 |
37 |
$721.28 |
| D1120 |
Prophylaxis - child |
90 |
77 |
$476.56 |