| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,009 |
582 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,826 |
1,720 |
$46K |
| D0330 |
Panoramic radiographic image |
1,079 |
1,026 |
$46K |
| D1110 |
Prophylaxis - adult |
865 |
818 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
797 |
530 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
590 |
578 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
169 |
133 |
$9K |
| D2331 |
|
62 |
42 |
$3K |
| D1120 |
Prophylaxis - child |
24 |
24 |
$1K |
| D2330 |
|
14 |
12 |
$633.60 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
12 |
$180.90 |