| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,008 |
1,196 |
$105K |
| D0330 |
Panoramic radiographic image |
1,463 |
1,403 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,062 |
1,974 |
$46K |
| D1110 |
Prophylaxis - adult |
1,167 |
1,124 |
$41K |
| D1120 |
Prophylaxis - child |
944 |
895 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
415 |
280 |
$22K |
| D0274 |
Bitewings - four radiographic images |
798 |
764 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,059 |
1,010 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
111 |
78 |
$7K |
| D1351 |
Sealant - per tooth |
403 |
100 |
$6K |
| D2332 |
|
46 |
26 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
70 |
50 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
236 |
227 |
$2K |
| D2394 |
|
19 |
14 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
66 |
64 |
$1K |
| D0272 |
Bitewings - two radiographic images |
34 |
34 |
$543.95 |
| D9110 |
|
19 |
18 |
$369.60 |
| D1999 |
|
36 |
22 |
$0.00 |