| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,717 |
965 |
$163K |
| D1110 |
Prophylaxis - adult |
976 |
970 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,319 |
1,312 |
$23K |
| D0330 |
Panoramic radiographic image |
395 |
395 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
486 |
481 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
186 |
139 |
$12K |
| D0272 |
Bitewings - two radiographic images |
530 |
525 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
146 |
86 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
701 |
651 |
$6K |
| D1120 |
Prophylaxis - child |
141 |
141 |
$5K |
| D2335 |
|
26 |
12 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
38 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
36 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$620.75 |
| D3221 |
|
15 |
12 |
$0.00 |