| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
7,214 |
3,451 |
$864K |
| D0140 |
Limited oral evaluation - problem focused |
5,932 |
5,160 |
$393K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,298 |
2,048 |
$155K |
| D0330 |
Panoramic radiographic image |
1,556 |
1,390 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
3,727 |
3,237 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
484 |
449 |
$34K |
| D0274 |
Bitewings - four radiographic images |
686 |
582 |
$29K |
| D1110 |
Prophylaxis - adult |
241 |
228 |
$17K |
| D4341 |
|
72 |
44 |
$17K |
| D4355 |
|
94 |
90 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
86 |
83 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48 |
38 |
$986.39 |
| D0270 |
|
46 |
44 |
$985.32 |
| D0350 |
|
18 |
15 |
$0.00 |
| D9930 |
|
23 |
12 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
17 |
13 |
$0.00 |