| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,813 |
2,019 |
$195K |
| D0330 |
Panoramic radiographic image |
1,158 |
1,132 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
312 |
243 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
1,952 |
1,902 |
$19K |
| D1110 |
Prophylaxis - adult |
691 |
672 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
606 |
588 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
244 |
237 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
132 |
105 |
$7K |
| D0274 |
Bitewings - four radiographic images |
406 |
396 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
325 |
318 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
31 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
314 |
299 |
$1K |