| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,058 |
1,584 |
$299K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,736 |
2,656 |
$74K |
| D1110 |
Prophylaxis - adult |
1,581 |
1,535 |
$66K |
| D0330 |
Panoramic radiographic image |
604 |
595 |
$32K |
| D5110 |
|
27 |
27 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,843 |
1,748 |
$14K |
| D0272 |
Bitewings - two radiographic images |
877 |
844 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
970 |
527 |
$5K |
| D2332 |
|
47 |
24 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
13 |
$802.32 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$582.02 |
| D9110 |
|
12 |
12 |
$232.47 |