| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,516 |
1,444 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,107 |
2,006 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
328 |
124 |
$20K |
| D0274 |
Bitewings - four radiographic images |
477 |
458 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
273 |
185 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
207 |
148 |
$7K |
| D0330 |
Panoramic radiographic image |
105 |
100 |
$6K |
| D1120 |
Prophylaxis - child |
261 |
254 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
52 |
$2K |