| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,555 |
877 |
$76K |
| D1110 |
Prophylaxis - adult |
1,663 |
1,537 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,392 |
2,192 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,255 |
1,155 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
571 |
511 |
$28K |
| D0274 |
Bitewings - four radiographic images |
747 |
691 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
445 |
252 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,730 |
1,567 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
452 |
400 |
$7K |
| D1120 |
Prophylaxis - child |
103 |
96 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
24 |
$2K |