| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,230 |
1,245 |
$214K |
| D0330 |
Panoramic radiographic image |
1,487 |
1,468 |
$71K |
| D0274 |
Bitewings - four radiographic images |
3,105 |
3,048 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,795 |
1,774 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
2,520 |
2,489 |
$49K |
| D1110 |
Prophylaxis - adult |
1,235 |
1,218 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
635 |
611 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
253 |
181 |
$19K |
| D2140 |
|
466 |
221 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,602 |
2,471 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
159 |
100 |
$9K |
| D2161 |
|
108 |
84 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
38 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
117 |
117 |
$2K |
| D2335 |
|
18 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
45 |
45 |
$1K |
| D0272 |
Bitewings - two radiographic images |
42 |
42 |
$420.00 |
| D1120 |
Prophylaxis - child |
17 |
17 |
$340.00 |