| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,438 |
1,385 |
$46K |
| D0330 |
Panoramic radiographic image |
1,292 |
1,235 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,474 |
1,432 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
325 |
151 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,259 |
1,193 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,828 |
1,768 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
820 |
792 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,441 |
1,366 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
244 |
226 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,062 |
642 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
173 |
75 |
$4K |
| D0270 |
|
17 |
17 |
$87.00 |