| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,397 |
1,352 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
508 |
478 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
816 |
801 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
24 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
42 |
$2K |
| D0274 |
Bitewings - four radiographic images |
63 |
63 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
150 |
136 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
15 |
$2K |