| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,320 |
454 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
427 |
267 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
630 |
566 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
361 |
200 |
$18K |
| D0330 |
Panoramic radiographic image |
360 |
357 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
486 |
485 |
$10K |
| D0274 |
Bitewings - four radiographic images |
119 |
116 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
20 |
$2K |
| D0272 |
Bitewings - two radiographic images |
95 |
95 |
$2K |