| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
454 |
235 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
541 |
533 |
$17K |
| D0330 |
Panoramic radiographic image |
232 |
228 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
322 |
317 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
220 |
218 |
$4K |
| D1110 |
Prophylaxis - adult |
70 |
68 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
300 |
295 |
$2K |
| D1120 |
Prophylaxis - child |
46 |
46 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
26 |
$2K |