| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,763 |
806 |
$187K |
| D0210 |
Intraoral - complete series of radiographic images |
1,462 |
1,408 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,635 |
1,580 |
$70K |
| D1110 |
Prophylaxis - adult |
1,148 |
1,115 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
358 |
215 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
425 |
255 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
458 |
447 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
25 |
$2K |
| D0274 |
Bitewings - four radiographic images |
84 |
84 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
46 |
46 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
19 |
19 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
15 |
$189.43 |