| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D5110 |
|
455 |
435 |
$278K |
| D5120 |
|
369 |
351 |
$208K |
| D0330 |
Panoramic radiographic image |
704 |
696 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
751 |
742 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
25 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
44 |
29 |
$3K |
| D2335 |
|
28 |
14 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
27 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
235 |
210 |
$2K |
| D0274 |
Bitewings - four radiographic images |
37 |
36 |
$1K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$601.30 |
| D0230 |
Intraoral - periapical each additional radiographic image |
54 |
36 |
$248.40 |