| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,839 |
656 |
$140K |
| D1110 |
Prophylaxis - adult |
3,232 |
3,136 |
$126K |
| D0330 |
Panoramic radiographic image |
1,770 |
1,688 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,447 |
2,368 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
2,369 |
2,203 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,494 |
2,418 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,125 |
2,076 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
595 |
416 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
243 |
161 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
3,421 |
3,246 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,181 |
1,158 |
$18K |
| D1120 |
Prophylaxis - child |
787 |
773 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
236 |
235 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,584 |
1,855 |
$13K |
| D2394 |
|
116 |
83 |
$13K |
| D1320 |
|
531 |
531 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
115 |
86 |
$7K |
| D2335 |
|
30 |
15 |
$5K |
| D0272 |
Bitewings - two radiographic images |
225 |
223 |
$2K |