| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,380 |
1,433 |
$282K |
| D1110 |
Prophylaxis - adult |
2,811 |
2,811 |
$141K |
| D0140 |
Limited oral evaluation - problem focused |
1,992 |
1,984 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,622 |
2,622 |
$71K |
| D0330 |
Panoramic radiographic image |
1,438 |
1,438 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,587 |
2,587 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
485 |
309 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
805 |
805 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,235 |
1,235 |
$20K |
| D1120 |
Prophylaxis - child |
489 |
489 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
758 |
751 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
46 |
30 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
62 |
53 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
51 |
$5K |
| D0272 |
Bitewings - two radiographic images |
179 |
179 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
259 |
215 |
$2K |