| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
821 |
194 |
$90K |
| D1110 |
Prophylaxis - adult |
672 |
632 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
505 |
466 |
$26K |
| D0274 |
Bitewings - four radiographic images |
541 |
509 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
325 |
275 |
$15K |
| D0330 |
Panoramic radiographic image |
197 |
175 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
763 |
671 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
190 |
176 |
$10K |
| D9410 |
|
49 |
33 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
13 |
$159.60 |