| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
983 |
218 |
$54K |
| D1110 |
Prophylaxis - adult |
1,211 |
1,180 |
$50K |
| D0330 |
Panoramic radiographic image |
923 |
873 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
986 |
927 |
$29K |
| D0274 |
Bitewings - four radiographic images |
764 |
736 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
934 |
911 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
471 |
452 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
177 |
108 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
513 |
496 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
29 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
252 |
239 |
$2K |