| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,762 |
2,031 |
$222K |
| D1110 |
Prophylaxis - adult |
5,510 |
5,320 |
$208K |
| D0330 |
Panoramic radiographic image |
3,684 |
3,534 |
$179K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,709 |
3,569 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
5,427 |
5,270 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
3,434 |
3,247 |
$79K |
| D0272 |
Bitewings - two radiographic images |
5,044 |
4,918 |
$58K |
| D1120 |
Prophylaxis - child |
2,274 |
2,228 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,746 |
2,683 |
$46K |
| D2161 |
|
229 |
208 |
$23K |
| D2160 |
|
330 |
255 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
3,631 |
3,399 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
230 |
157 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
18 |
12 |
$9K |
| D2335 |
|
93 |
64 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,240 |
830 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
38 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
25 |
$3K |
| D0274 |
Bitewings - four radiographic images |
30 |
30 |
$1K |
| D2394 |
|
14 |
12 |
$1K |