| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
19,915 |
6,148 |
$960K |
| D1110 |
Prophylaxis - adult |
10,419 |
8,211 |
$389K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,168 |
7,239 |
$305K |
| D0120 |
Periodic oral evaluation - established patient |
12,176 |
9,713 |
$258K |
| D0330 |
Panoramic radiographic image |
5,118 |
3,541 |
$166K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,072 |
1,358 |
$162K |
| D0272 |
Bitewings - two radiographic images |
4,021 |
3,499 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,730 |
1,246 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
5,512 |
4,162 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
466 |
334 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
265 |
203 |
$25K |
| D5110 |
|
46 |
44 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
850 |
818 |
$19K |
| D0274 |
Bitewings - four radiographic images |
750 |
597 |
$16K |
| D5130 |
|
26 |
25 |
$11K |
| D1120 |
Prophylaxis - child |
187 |
187 |
$8K |
| D2332 |
|
44 |
29 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
369 |
260 |
$3K |
| D2335 |
|
20 |
17 |
$2K |
| D2331 |
|
20 |
14 |
$2K |
| D1999 |
|
269 |
209 |
$0.00 |