| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
4,371 |
4,142 |
$159K |
| D0330 |
Panoramic radiographic image |
1,921 |
1,893 |
$134K |
| D1110 |
Prophylaxis - adult |
2,396 |
2,374 |
$122K |
| D7140 |
Extraction, erupted tooth or exposed root |
967 |
444 |
$96K |
| D0274 |
Bitewings - four radiographic images |
2,137 |
2,113 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,417 |
2,394 |
$71K |
| D1206 |
Topical application of fluoride varnish |
2,289 |
2,263 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
3,734 |
3,523 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
544 |
352 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,170 |
1,155 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,782 |
1,482 |
$36K |
| D1120 |
Prophylaxis - child |
792 |
788 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
277 |
164 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
25 |
$7K |
| D0272 |
Bitewings - two radiographic images |
237 |
232 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
41 |
25 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$2K |
| D1330 |
|
32 |
32 |
$864.32 |