| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,037 |
461 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
695 |
405 |
$34K |
| D1110 |
Prophylaxis - adult |
1,062 |
992 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
571 |
523 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
835 |
768 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
853 |
770 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,027 |
976 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
349 |
207 |
$16K |
| D1120 |
Prophylaxis - child |
474 |
457 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
556 |
541 |
$8K |
| D0274 |
Bitewings - four radiographic images |
395 |
373 |
$7K |
| D0330 |
Panoramic radiographic image |
104 |
101 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
54 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
635 |
577 |
$3K |
| D2335 |
|
23 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
148 |
79 |
$714.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$133.50 |