| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,177 |
1,619 |
$184K |
| D1110 |
Prophylaxis - adult |
4,630 |
4,500 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
4,887 |
4,725 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
3,487 |
3,206 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,263 |
954 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,707 |
2,628 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
1,459 |
1,369 |
$71K |
| D1120 |
Prophylaxis - child |
1,220 |
1,202 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
727 |
493 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,423 |
3,202 |
$36K |
| D0330 |
Panoramic radiographic image |
434 |
430 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
698 |
692 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
496 |
451 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
135 |
111 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
949 |
428 |
$7K |
| D2140 |
|
84 |
63 |
$4K |
| D9310 |
|
214 |
207 |
$4K |
| D2940 |
|
25 |
24 |
$761.00 |
| D0270 |
|
43 |
40 |
$223.16 |