| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,331 |
1,279 |
$157K |
| D1110 |
Prophylaxis - adult |
2,145 |
2,099 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,761 |
1,739 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,221 |
2,175 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
734 |
719 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
123 |
94 |
$9K |
| D0330 |
Panoramic radiographic image |
202 |
200 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
63 |
$3K |
| D0272 |
Bitewings - two radiographic images |
148 |
137 |
$3K |
| D0274 |
Bitewings - four radiographic images |
55 |
54 |
$2K |