| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,651 |
721 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
984 |
541 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
587 |
372 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
693 |
678 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,082 |
1,065 |
$29K |
| D1110 |
Prophylaxis - adult |
488 |
477 |
$20K |
| D0330 |
Panoramic radiographic image |
298 |
298 |
$17K |
| D0274 |
Bitewings - four radiographic images |
637 |
632 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
562 |
549 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,217 |
409 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
174 |
106 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
872 |
854 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
59 |
46 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
56 |
$2K |
| D2394 |
|
17 |
13 |
$1K |