| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,349 |
567 |
$174K |
| D0140 |
Limited oral evaluation - problem focused |
648 |
635 |
$30K |
| D1110 |
Prophylaxis - adult |
442 |
442 |
$29K |
| D0330 |
Panoramic radiographic image |
501 |
491 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
370 |
364 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
138 |
108 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
74 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
257 |
257 |
$8K |
| D0274 |
Bitewings - four radiographic images |
310 |
310 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
605 |
584 |
$7K |
| D2332 |
|
15 |
12 |
$2K |
| D2331 |
|
16 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
122 |
121 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$684.00 |