| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,342 |
401 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,462 |
2,392 |
$65K |
| D0330 |
Panoramic radiographic image |
1,515 |
1,471 |
$62K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
876 |
428 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,234 |
391 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
610 |
298 |
$30K |
| D2330 |
|
645 |
242 |
$27K |
| D1110 |
Prophylaxis - adult |
445 |
435 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,073 |
1,952 |
$16K |
| D0274 |
Bitewings - four radiographic images |
535 |
513 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
375 |
343 |
$11K |
| D2332 |
|
175 |
90 |
$11K |
| D2335 |
|
91 |
40 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
114 |
66 |
$6K |
| D9110 |
|
78 |
76 |
$4K |
| D2331 |
|
20 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
51 |
51 |
$937.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
14 |
$106.29 |