| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
991 |
597 |
$43K |
| D1110 |
Prophylaxis - adult |
1,032 |
926 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,167 |
1,076 |
$29K |
| D1120 |
Prophylaxis - child |
639 |
597 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,116 |
1,032 |
$22K |
| D2950 |
|
262 |
197 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
1,013 |
927 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
283 |
225 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
527 |
496 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
273 |
195 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,867 |
1,647 |
$9K |
| D4341 |
|
50 |
28 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,156 |
853 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
124 |
93 |
$8K |
| D0272 |
Bitewings - two radiographic images |
759 |
704 |
$6K |
| D3310 |
|
39 |
26 |
$6K |
| D0274 |
Bitewings - four radiographic images |
317 |
278 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
131 |
124 |
$1K |
| D2332 |
|
17 |
12 |
$1K |