| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,599 |
757 |
$315K |
| D5110 |
|
105 |
105 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,831 |
1,828 |
$70K |
| D1110 |
Prophylaxis - adult |
1,605 |
1,600 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
303 |
197 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,145 |
1,133 |
$38K |
| D0330 |
Panoramic radiographic image |
740 |
737 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,438 |
1,430 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,466 |
2,439 |
$30K |
| D5120 |
|
36 |
36 |
$28K |
| D2740 |
Crown - porcelain/ceramic |
52 |
37 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
173 |
108 |
$18K |
| D0274 |
Bitewings - four radiographic images |
557 |
549 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
779 |
773 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
66 |
66 |
$4K |
| D2950 |
|
16 |
14 |
$2K |
| D7310 |
|
14 |
13 |
$2K |
| D4910 |
|
12 |
12 |
$763.36 |