| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,323 |
1,321 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,012 |
426 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,319 |
1,316 |
$23K |
| D0274 |
Bitewings - four radiographic images |
578 |
577 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,539 |
1,512 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
523 |
520 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
913 |
790 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
25 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
74 |
74 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
13 |
$962.31 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$396.63 |