| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,179 |
823 |
$147K |
| D1110 |
Prophylaxis - adult |
1,677 |
1,604 |
$64K |
| D0330 |
Panoramic radiographic image |
538 |
500 |
$21K |
| D0274 |
Bitewings - four radiographic images |
845 |
800 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
716 |
643 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
789 |
762 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
619 |
589 |
$15K |
| D1206 |
Topical application of fluoride varnish |
1,535 |
1,462 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
123 |
119 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
489 |
424 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
55 |
55 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
13 |
$1K |
| D9311 |
|
33 |
30 |
$360.00 |
| D1330 |
|
1,535 |
1,460 |
$0.00 |
| D0418 |
|
168 |
162 |
$0.00 |