| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,557 |
1,554 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
826 |
804 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,417 |
1,414 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
336 |
172 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
227 |
227 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
384 |
384 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,419 |
1,381 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
57 |
39 |
$4K |
| D0274 |
Bitewings - four radiographic images |
252 |
252 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
266 |
264 |
$1K |
| D1120 |
Prophylaxis - child |
25 |
25 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$1K |