| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,035 |
413 |
$133K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
720 |
406 |
$95K |
| D1110 |
Prophylaxis - adult |
1,331 |
1,313 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,459 |
1,429 |
$79K |
| D0330 |
Panoramic radiographic image |
968 |
952 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
744 |
722 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
318 |
183 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
986 |
974 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,308 |
1,279 |
$31K |
| D1351 |
Sealant - per tooth |
669 |
126 |
$24K |
| D1206 |
Topical application of fluoride varnish |
945 |
926 |
$24K |
| D1120 |
Prophylaxis - child |
467 |
461 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
507 |
504 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,110 |
1,070 |
$12K |
| D2332 |
|
39 |
25 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
583 |
565 |
$4K |
| D0272 |
Bitewings - two radiographic images |
162 |
162 |
$3K |
| D1330 |
|
236 |
229 |
$1K |