| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
3,805 |
3,260 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,239 |
989 |
$139K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,895 |
1,117 |
$138K |
| D1120 |
Prophylaxis - child |
3,857 |
3,445 |
$104K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,131 |
894 |
$97K |
| D0330 |
Panoramic radiographic image |
1,448 |
1,286 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,432 |
2,277 |
$68K |
| D0272 |
Bitewings - two radiographic images |
3,749 |
3,347 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,219 |
984 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
290 |
150 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,686 |
1,424 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
146 |
59 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D2140 |
|
14 |
12 |
$926.48 |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
25 |
$289.16 |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$207.00 |