| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,220 |
3,133 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,106 |
2,043 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
1,691 |
1,638 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
774 |
380 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
1,650 |
1,602 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
393 |
257 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
999 |
923 |
$6K |
| D0274 |
Bitewings - four radiographic images |
1,411 |
1,356 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,692 |
1,817 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
2,594 |
2,329 |
$4K |
| D0330 |
Panoramic radiographic image |
347 |
337 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
86 |
52 |
$2K |
| D0272 |
Bitewings - two radiographic images |
29 |
25 |
$95.00 |