| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,473 |
558 |
$249K |
| D0140 |
Limited oral evaluation - problem focused |
1,457 |
1,299 |
$50K |
| D1110 |
Prophylaxis - adult |
474 |
452 |
$25K |
| D0330 |
Panoramic radiographic image |
421 |
390 |
$24K |
| D0274 |
Bitewings - four radiographic images |
438 |
410 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
140 |
93 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
577 |
526 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
739 |
672 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
36 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
155 |
147 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
193 |
165 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
78 |
73 |
$3K |
| D1120 |
Prophylaxis - child |
59 |
43 |
$2K |