| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,232 |
1,028 |
$374K |
| D2750 |
|
447 |
254 |
$209K |
| D7230 |
|
590 |
304 |
$136K |
| D0330 |
Panoramic radiographic image |
2,010 |
1,981 |
$86K |
| D0140 |
Limited oral evaluation - problem focused |
1,923 |
1,892 |
$76K |
| D1110 |
Prophylaxis - adult |
975 |
961 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
787 |
770 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
302 |
145 |
$35K |
| D2950 |
|
408 |
246 |
$35K |
| D7240 |
Removal of impacted tooth - completely bony |
105 |
58 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,192 |
1,179 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
873 |
863 |
$23K |
| D1206 |
Topical application of fluoride varnish |
858 |
843 |
$21K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
26 |
$20K |
| D1120 |
Prophylaxis - child |
444 |
441 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,512 |
1,482 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
265 |
265 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
74 |
73 |
$603.52 |
| D1330 |
|
77 |
71 |
$477.60 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$376.92 |