| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,246 |
1,005 |
$309K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,990 |
1,288 |
$262K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,979 |
1,044 |
$203K |
| D0140 |
Limited oral evaluation - problem focused |
1,877 |
1,863 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
312 |
265 |
$48K |
| D2750 |
|
65 |
53 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
813 |
812 |
$31K |
| D1110 |
Prophylaxis - adult |
176 |
176 |
$7K |
| D0330 |
Panoramic radiographic image |
95 |
95 |
$5K |
| D0274 |
Bitewings - four radiographic images |
163 |
163 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
202 |
200 |
$4K |
| D2950 |
|
30 |
28 |
$4K |
| D1206 |
Topical application of fluoride varnish |
200 |
200 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
246 |
244 |
$3K |
| D1120 |
Prophylaxis - child |
65 |
65 |
$2K |
| D9310 |
|
12 |
12 |
$515.52 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$265.46 |