| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,110 |
2,200 |
$255K |
| D0330 |
Panoramic radiographic image |
2,502 |
2,409 |
$126K |
| D1110 |
Prophylaxis - adult |
3,249 |
3,150 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
3,641 |
3,536 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,196 |
2,126 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,553 |
1,508 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
380 |
285 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,321 |
1,285 |
$20K |
| D1120 |
Prophylaxis - child |
878 |
853 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
231 |
134 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
27 |
$2K |
| D7220 |
|
18 |
12 |
$2K |
| D2330 |
|
21 |
12 |
$1K |