| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,290 |
1,265 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,897 |
672 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,142 |
914 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,345 |
1,326 |
$21K |
| D0330 |
Panoramic radiographic image |
1,000 |
794 |
$19K |
| D0274 |
Bitewings - four radiographic images |
839 |
828 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
174 |
103 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
421 |
421 |
$9K |
| D1120 |
Prophylaxis - child |
231 |
231 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
829 |
627 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
463 |
135 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
25 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
69 |
$2K |
| D4341 |
|
129 |
82 |
$0.00 |