| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,858 |
1,752 |
$81K |
| D0330 |
Panoramic radiographic image |
1,791 |
1,682 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,290 |
2,166 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,263 |
2,142 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
449 |
196 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
580 |
556 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
237 |
170 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
192 |
107 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
82 |
51 |
$9K |
| D2332 |
|
107 |
44 |
$6K |
| D2394 |
|
93 |
55 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
49 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
170 |
161 |
$1K |
| D2335 |
|
15 |
12 |
$1K |