| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,811 |
1,770 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
1,104 |
1,080 |
$48K |
| D0330 |
Panoramic radiographic image |
406 |
398 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
394 |
387 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
212 |
205 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
68 |
38 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
292 |
276 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
13 |
$3K |
| D0272 |
Bitewings - two radiographic images |
55 |
53 |
$2K |