| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,584 |
351 |
$108K |
| D1110 |
Prophylaxis - adult |
1,147 |
1,147 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,827 |
1,827 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
395 |
253 |
$38K |
| D0330 |
Panoramic radiographic image |
678 |
678 |
$34K |
| D1120 |
Prophylaxis - child |
974 |
974 |
$29K |
| D0274 |
Bitewings - four radiographic images |
732 |
732 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
363 |
215 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,249 |
1,249 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
528 |
527 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
317 |
317 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64 |
25 |
$8K |
| D0272 |
Bitewings - two radiographic images |
279 |
279 |
$5K |