| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,177 |
1,134 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
1,560 |
1,451 |
$33K |
| D0330 |
Panoramic radiographic image |
432 |
396 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,565 |
612 |
$29K |
| D0274 |
Bitewings - four radiographic images |
616 |
579 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
579 |
522 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
345 |
316 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
361 |
344 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
102 |
48 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
67 |
38 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
26 |
$3K |
| D0270 |
|
12 |
12 |
$276.00 |