| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,883 |
1,457 |
$151K |
| D1110 |
Prophylaxis - adult |
2,929 |
2,836 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,265 |
4,168 |
$110K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,214 |
1,036 |
$99K |
| D0330 |
Panoramic radiographic image |
2,290 |
2,227 |
$97K |
| D1120 |
Prophylaxis - child |
900 |
859 |
$42K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
486 |
310 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,625 |
1,556 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
385 |
288 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
472 |
459 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
307 |
298 |
$10K |
| D2331 |
|
60 |
37 |
$4K |
| D2330 |
|
51 |
31 |
$2K |
| D0274 |
Bitewings - four radiographic images |
86 |
83 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
35 |
28 |
$2K |
| D1999 |
|
17 |
16 |
$0.00 |