| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
8,682 |
3,695 |
$462K |
| D0330 |
Panoramic radiographic image |
4,231 |
4,231 |
$209K |
| D0140 |
Limited oral evaluation - problem focused |
7,183 |
7,154 |
$157K |
| D1110 |
Prophylaxis - adult |
1,870 |
1,869 |
$93K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
506 |
443 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
504 |
504 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
221 |
178 |
$19K |
| D0272 |
Bitewings - two radiographic images |
912 |
912 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
540 |
540 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
968 |
960 |
$11K |
| D0274 |
Bitewings - four radiographic images |
52 |
52 |
$1K |