| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,665 |
2,660 |
$209K |
| D2750 |
|
384 |
325 |
$107K |
| D0140 |
Limited oral evaluation - problem focused |
5,437 |
4,893 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
3,403 |
3,224 |
$91K |
| D1110 |
Prophylaxis - adult |
1,741 |
1,678 |
$77K |
| D2950 |
|
777 |
652 |
$52K |
| D1120 |
Prophylaxis - child |
1,160 |
1,107 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,988 |
1,921 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
5,845 |
5,205 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,029 |
984 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
504 |
390 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,548 |
2,365 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
360 |
304 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
260 |
211 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,382 |
2,164 |
$9K |
| D3310 |
|
38 |
28 |
$6K |
| D2753 |
|
13 |
13 |
$3K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$203.40 |