| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,218 |
855 |
$153K |
| D0140 |
Limited oral evaluation - problem focused |
1,932 |
1,788 |
$64K |
| D0330 |
Panoramic radiographic image |
1,435 |
1,375 |
$59K |
| D1110 |
Prophylaxis - adult |
950 |
925 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,463 |
1,424 |
$40K |
| D0274 |
Bitewings - four radiographic images |
548 |
537 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
934 |
887 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
134 |
83 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
330 |
322 |
$5K |
| D1120 |
Prophylaxis - child |
86 |
83 |
$4K |
| D0272 |
Bitewings - two radiographic images |
175 |
173 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
288 |
276 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
41 |
41 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |