| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,559 |
1,538 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,094 |
2,063 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
743 |
702 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
220 |
122 |
$13K |
| D0274 |
Bitewings - four radiographic images |
339 |
334 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
68 |
51 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
464 |
433 |
$6K |
| D1120 |
Prophylaxis - child |
88 |
87 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
14 |
$1K |
| D9110 |
|
17 |
17 |
$675.99 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
14 |
$539.33 |