| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,319 |
678 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,059 |
526 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
772 |
483 |
$41K |
| D1110 |
Prophylaxis - adult |
1,072 |
1,064 |
$38K |
| D0330 |
Panoramic radiographic image |
951 |
949 |
$34K |
| D0274 |
Bitewings - four radiographic images |
945 |
935 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,195 |
1,193 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
706 |
703 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
143 |
116 |
$8K |
| D2330 |
|
187 |
104 |
$8K |
| D5214 |
|
16 |
14 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
901 |
891 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
764 |
733 |
$6K |
| D1120 |
Prophylaxis - child |
161 |
160 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
252 |
251 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
32 |
$1K |
| D2331 |
|
18 |
12 |
$1K |