| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,693 |
550 |
$135K |
| D9420 |
|
1,593 |
1,141 |
$131K |
| D0140 |
Limited oral evaluation - problem focused |
2,235 |
1,731 |
$65K |
| D1110 |
Prophylaxis - adult |
1,566 |
1,089 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,933 |
1,249 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,769 |
730 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,537 |
1,136 |
$17K |
| D0274 |
Bitewings - four radiographic images |
517 |
342 |
$9K |
| D0160 |
|
180 |
138 |
$9K |
| D1206 |
Topical application of fluoride varnish |
1,083 |
634 |
$8K |
| D1120 |
Prophylaxis - child |
325 |
217 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
100 |
39 |
$6K |
| D0272 |
Bitewings - two radiographic images |
276 |
249 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
63 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
36 |
$2K |
| D0330 |
Panoramic radiographic image |
18 |
17 |
$712.55 |