| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
868 |
292 |
$54K |
| D1110 |
Prophylaxis - adult |
432 |
413 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
541 |
437 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
511 |
462 |
$13K |
| D0330 |
Panoramic radiographic image |
170 |
151 |
$10K |
| D0272 |
Bitewings - two radiographic images |
388 |
362 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
611 |
514 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
242 |
210 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
111 |
102 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
25 |
25 |
$837.00 |