| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,818 |
1,690 |
$236K |
| D1110 |
Prophylaxis - adult |
2,874 |
2,874 |
$143K |
| D0140 |
Limited oral evaluation - problem focused |
2,811 |
2,783 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
3,360 |
3,360 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
686 |
426 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,205 |
2,205 |
$59K |
| D1120 |
Prophylaxis - child |
1,500 |
1,500 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
534 |
277 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,371 |
2,371 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,188 |
3,110 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
785 |
785 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,127 |
1,127 |
$21K |
| D0330 |
Panoramic radiographic image |
402 |
402 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
332 |
332 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
176 |
161 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |