| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,776 |
715 |
$104K |
| D1110 |
Prophylaxis - adult |
1,375 |
1,369 |
$72K |
| D0330 |
Panoramic radiographic image |
1,272 |
1,264 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,017 |
688 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,620 |
1,614 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,458 |
1,450 |
$41K |
| D1120 |
Prophylaxis - child |
489 |
485 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
336 |
246 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
597 |
585 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
787 |
776 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,746 |
996 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,670 |
1,638 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
669 |
665 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
234 |
188 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64 |
51 |
$5K |
| D1206 |
Topical application of fluoride varnish |
157 |
157 |
$2K |
| D4341 |
|
25 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
76 |
76 |
$1K |