| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,240 |
559 |
$84K |
| D1110 |
Prophylaxis - adult |
1,228 |
1,159 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,683 |
1,613 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,868 |
1,786 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,531 |
2,107 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,523 |
2,394 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
820 |
778 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
91 |
53 |
$7K |
| D2332 |
|
26 |
12 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
134 |
117 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
72 |
55 |
$2K |
| D1999 |
|
789 |
718 |
$0.00 |