| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,978 |
710 |
$213K |
| D1110 |
Prophylaxis - adult |
3,021 |
3,010 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
3,436 |
3,422 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
684 |
513 |
$40K |
| D0330 |
Panoramic radiographic image |
1,055 |
1,047 |
$36K |
| D5110 |
|
63 |
62 |
$29K |
| D0274 |
Bitewings - four radiographic images |
790 |
787 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,298 |
1,295 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
972 |
969 |
$18K |
| D1120 |
Prophylaxis - child |
535 |
534 |
$16K |
| D5120 |
|
28 |
28 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
602 |
597 |
$11K |
| D1351 |
Sealant - per tooth |
312 |
82 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
93 |
68 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
81 |
$5K |
| D2332 |
|
49 |
38 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
299 |
296 |
$2K |
| D9110 |
|
63 |
63 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
51 |
51 |
$732.15 |