| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,442 |
647 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,207 |
2,120 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
701 |
510 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
543 |
398 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
809 |
780 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
640 |
601 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
548 |
525 |
$3K |
| D9110 |
|
31 |
25 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$880.65 |