| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,654 |
1,415 |
$115K |
| D0274 |
Bitewings - four radiographic images |
1,915 |
1,610 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
1,476 |
1,303 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
678 |
578 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
219 |
93 |
$30K |
| D0330 |
Panoramic radiographic image |
386 |
314 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,189 |
995 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
884 |
318 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
138 |
$8K |
| D1120 |
Prophylaxis - child |
124 |
109 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
15 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
68 |
55 |
$1K |