| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,251 |
2,042 |
$75K |
| D1110 |
Prophylaxis - adult |
1,807 |
1,623 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
4,055 |
3,623 |
$52K |
| D0330 |
Panoramic radiographic image |
1,179 |
1,065 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
544 |
368 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
691 |
351 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,658 |
1,500 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
977 |
891 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,555 |
1,392 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,781 |
1,959 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
302 |
167 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$2K |
| D2331 |
|
14 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
72 |
68 |
$1K |
| D4355 |
|
14 |
12 |
$698.44 |