| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,308 |
1,550 |
$186K |
| D1110 |
Prophylaxis - adult |
4,012 |
3,755 |
$132K |
| D0140 |
Limited oral evaluation - problem focused |
5,069 |
4,620 |
$127K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,309 |
5,032 |
$97K |
| D0274 |
Bitewings - four radiographic images |
3,282 |
3,101 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,908 |
3,696 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,237 |
4,045 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
821 |
422 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
983 |
531 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,249 |
1,171 |
$52K |
| D1120 |
Prophylaxis - child |
1,217 |
1,164 |
$51K |
| D2140 |
|
236 |
118 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,074 |
969 |
$11K |
| D0272 |
Bitewings - two radiographic images |
450 |
430 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
85 |
62 |
$5K |
| D7971 |
|
13 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
15 |
$2K |
| D2332 |
|
14 |
12 |
$1K |
| D0270 |
|
154 |
141 |
$944.58 |
| D2950 |
|
22 |
12 |
$773.76 |