| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
2,718 |
1,143 |
$168K |
| D2335 |
|
1,553 |
623 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
3,150 |
2,335 |
$81K |
| D1110 |
Prophylaxis - adult |
1,434 |
1,279 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,367 |
2,106 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
712 |
314 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,777 |
1,574 |
$38K |
| D1120 |
Prophylaxis - child |
642 |
582 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
500 |
255 |
$19K |
| D0330 |
Panoramic radiographic image |
565 |
527 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,002 |
1,789 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
241 |
102 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,356 |
1,924 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,108 |
550 |
$6K |
| D4341 |
|
33 |
25 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
14 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
29 |
27 |
$715.00 |
| D9986 |
|
97 |
81 |
$243.00 |