| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,586 |
1,744 |
$194K |
| D0330 |
Panoramic radiographic image |
4,055 |
3,859 |
$175K |
| D1110 |
Prophylaxis - adult |
2,857 |
2,777 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,575 |
3,406 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,702 |
1,115 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
1,905 |
1,767 |
$39K |
| D0274 |
Bitewings - four radiographic images |
2,077 |
2,028 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
799 |
532 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
2,357 |
2,206 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
396 |
313 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,206 |
1,164 |
$17K |
| D1120 |
Prophylaxis - child |
734 |
711 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,057 |
1,968 |
$10K |
| D2394 |
|
55 |
43 |
$4K |
| D0272 |
Bitewings - two radiographic images |
372 |
364 |
$3K |
| D2331 |
|
23 |
17 |
$1K |