| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,634 |
1,633 |
$189K |
| D1110 |
Prophylaxis - adult |
3,973 |
3,856 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
5,596 |
5,443 |
$93K |
| D0274 |
Bitewings - four radiographic images |
3,569 |
3,452 |
$69K |
| D0330 |
Panoramic radiographic image |
1,366 |
1,306 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,107 |
3,045 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,637 |
1,573 |
$42K |
| D1120 |
Prophylaxis - child |
2,007 |
1,971 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
680 |
416 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
377 |
251 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,195 |
1,164 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
737 |
706 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
76 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
13 |
$864.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
47 |
15 |
$155.00 |