| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,421 |
292 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,140 |
1,086 |
$28K |
| D0330 |
Panoramic radiographic image |
598 |
575 |
$26K |
| D1110 |
Prophylaxis - adult |
710 |
690 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
232 |
152 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
134 |
62 |
$6K |
| D0274 |
Bitewings - four radiographic images |
333 |
326 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
228 |
226 |
$5K |
| D1120 |
Prophylaxis - child |
191 |
190 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
151 |
146 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
61 |
61 |
$929.10 |
| D0220 |
Intraoral - periapical first radiographic image |
99 |
90 |
$451.00 |