| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,135 |
1,106 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,094 |
1,034 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
180 |
126 |
$18K |
| D0274 |
Bitewings - four radiographic images |
478 |
463 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
657 |
619 |
$9K |
| D0330 |
Panoramic radiographic image |
143 |
138 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
476 |
323 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
136 |
131 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
86 |
82 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
48 |
27 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
24 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$2K |