| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,847 |
1,160 |
$116K |
| D0330 |
Panoramic radiographic image |
734 |
719 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
282 |
200 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
1,078 |
1,064 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
155 |
124 |
$9K |
| D1110 |
Prophylaxis - adult |
403 |
395 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
292 |
280 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
493 |
477 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
59 |
49 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
176 |
167 |
$2K |
| D0274 |
Bitewings - four radiographic images |
169 |
164 |
$2K |
| D2330 |
|
15 |
13 |
$822.00 |
| D2331 |
|
15 |
13 |
$816.80 |
| D0220 |
Intraoral - periapical first radiographic image |
111 |
102 |
$468.00 |