| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
778 |
334 |
$28K |
| D0330 |
Panoramic radiographic image |
556 |
540 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
720 |
693 |
$17K |
| D1120 |
Prophylaxis - child |
363 |
346 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
287 |
183 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
368 |
361 |
$11K |
| D1110 |
Prophylaxis - adult |
272 |
266 |
$10K |
| D0274 |
Bitewings - four radiographic images |
389 |
376 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
129 |
72 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
188 |
116 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
118 |
82 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
473 |
455 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
253 |
247 |
$2K |
| D0272 |
Bitewings - two radiographic images |
45 |
39 |
$652.05 |
| D9987 |
|
414 |
350 |
$0.00 |
| D9986 |
|
223 |
187 |
$0.00 |