| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,716 |
814 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
1,320 |
1,096 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,120 |
950 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
264 |
255 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
140 |
138 |
$4K |
| D1120 |
Prophylaxis - child |
76 |
75 |
$3K |
| D0272 |
Bitewings - two radiographic images |
239 |
235 |
$2K |
| D1110 |
Prophylaxis - adult |
38 |
38 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
59 |
58 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
53 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
14 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$493.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
13 |
$60.80 |