| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,365 |
1,765 |
$201K |
| D0140 |
Limited oral evaluation - problem focused |
3,171 |
2,821 |
$113K |
| D1110 |
Prophylaxis - adult |
2,117 |
2,036 |
$75K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
458 |
210 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,109 |
1,029 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,337 |
2,964 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,736 |
1,637 |
$43K |
| D0330 |
Panoramic radiographic image |
734 |
674 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
418 |
194 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
221 |
146 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,116 |
1,052 |
$19K |
| D2330 |
|
347 |
158 |
$19K |
| D1120 |
Prophylaxis - child |
494 |
468 |
$13K |
| D2335 |
|
88 |
50 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
632 |
589 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
577 |
381 |
$7K |
| D0274 |
Bitewings - four radiographic images |
84 |
79 |
$2K |
| D9110 |
|
29 |
27 |
$1K |