| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
689 |
293 |
$46K |
| D1110 |
Prophylaxis - adult |
939 |
924 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,032 |
1,012 |
$19K |
| D0330 |
Panoramic radiographic image |
453 |
445 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
280 |
211 |
$16K |
| D1120 |
Prophylaxis - child |
417 |
412 |
$13K |
| D0274 |
Bitewings - four radiographic images |
436 |
428 |
$11K |
| D1206 |
Topical application of fluoride varnish |
546 |
536 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
176 |
142 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
415 |
408 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
31 |
$2K |
| D9110 |
|
64 |
61 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
161 |
153 |
$1K |
| D2331 |
|
18 |
13 |
$1K |
| D1999 |
|
27 |
26 |
$0.00 |