| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
540 |
179 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
473 |
467 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
196 |
96 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
347 |
345 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
91 |
56 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
698 |
682 |
$8K |
| D1110 |
Prophylaxis - adult |
159 |
158 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
170 |
167 |
$5K |
| D2950 |
|
42 |
39 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
202 |
199 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
410 |
408 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
16 |
$3K |
| D2140 |
|
24 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
68 |
68 |
$2K |