| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,528 |
664 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
743 |
402 |
$45K |
| D0330 |
Panoramic radiographic image |
943 |
889 |
$32K |
| D2335 |
|
405 |
219 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,182 |
1,107 |
$26K |
| D2394 |
|
203 |
137 |
$13K |
| D0272 |
Bitewings - two radiographic images |
662 |
612 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
65 |
$4K |
| D1110 |
Prophylaxis - adult |
125 |
108 |
$4K |