| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,395 |
650 |
$95K |
| D1120 |
Prophylaxis - child |
3,275 |
2,797 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,876 |
2,492 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,518 |
2,984 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,764 |
2,306 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
887 |
770 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,353 |
1,139 |
$14K |
| D0330 |
Panoramic radiographic image |
192 |
166 |
$8K |
| D2140 |
|
89 |
55 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
296 |
218 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
19 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34 |
13 |
$2K |
| D1110 |
Prophylaxis - adult |
81 |
66 |
$475.00 |
| D1203 |
|
50 |
40 |
$0.00 |