| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,288 |
462 |
$45K |
| D0330 |
Panoramic radiographic image |
1,010 |
965 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
886 |
841 |
$23K |
| D1110 |
Prophylaxis - adult |
504 |
483 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
713 |
685 |
$20K |
| D0272 |
Bitewings - two radiographic images |
711 |
670 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
62 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
446 |
432 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
26 |
$2K |