| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,278 |
438 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,356 |
626 |
$99K |
| D1110 |
Prophylaxis - adult |
1,867 |
1,804 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,523 |
2,435 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
3,381 |
3,269 |
$82K |
| D1120 |
Prophylaxis - child |
2,123 |
2,057 |
$73K |
| D0330 |
Panoramic radiographic image |
1,521 |
1,458 |
$71K |
| D1206 |
Topical application of fluoride varnish |
3,548 |
3,424 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
537 |
294 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,455 |
1,407 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
576 |
510 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
539 |
520 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
541 |
502 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
517 |
478 |
$7K |