| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,135 |
3,094 |
$131K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,313 |
447 |
$108K |
| D0274 |
Bitewings - four radiographic images |
3,436 |
3,392 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,634 |
2,599 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
1,292 |
1,237 |
$73K |
| D0330 |
Panoramic radiographic image |
1,174 |
1,164 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,860 |
2,827 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
393 |
210 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
358 |
240 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
845 |
811 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,133 |
1,120 |
$23K |
| D2394 |
|
253 |
182 |
$22K |
| D1120 |
Prophylaxis - child |
468 |
459 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,690 |
1,636 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,178 |
495 |
$10K |
| D2332 |
|
45 |
26 |
$7K |
| D0272 |
Bitewings - two radiographic images |
85 |
85 |
$1K |
| D1320 |
|
47 |
46 |
$1K |