| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,089 |
310 |
$74K |
| D1110 |
Prophylaxis - adult |
1,709 |
1,680 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,236 |
2,198 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,415 |
2,383 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
673 |
653 |
$39K |
| D1120 |
Prophylaxis - child |
855 |
839 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
996 |
967 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,292 |
1,196 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
214 |
125 |
$13K |
| D0274 |
Bitewings - four radiographic images |
484 |
480 |
$12K |
| D0272 |
Bitewings - two radiographic images |
248 |
245 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
287 |
257 |
$3K |
| D9110 |
|
43 |
41 |
$2K |
| D2950 |
|
15 |
13 |
$399.21 |