| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
911 |
339 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
813 |
550 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,585 |
1,582 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
467 |
298 |
$26K |
| D1120 |
Prophylaxis - child |
780 |
776 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
824 |
810 |
$24K |
| D1110 |
Prophylaxis - adult |
328 |
326 |
$15K |
| D0274 |
Bitewings - four radiographic images |
409 |
408 |
$12K |
| D1206 |
Topical application of fluoride varnish |
605 |
604 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
192 |
192 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
708 |
698 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
279 |
277 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
65 |
50 |
$6K |