| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
18,073 |
6,646 |
$795K |
| D0330 |
Panoramic radiographic image |
6,987 |
6,341 |
$328K |
| D0274 |
Bitewings - four radiographic images |
8,795 |
8,045 |
$242K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,268 |
4,822 |
$237K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,985 |
1,259 |
$174K |
| D0220 |
Intraoral - periapical first radiographic image |
7,994 |
7,052 |
$92K |
| D1110 |
Prophylaxis - adult |
2,437 |
2,271 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
3,082 |
2,751 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
699 |
485 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,316 |
2,124 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,953 |
2,434 |
$34K |
| D4341 |
|
154 |
72 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
336 |
209 |
$17K |
| D4910 |
|
153 |
146 |
$13K |
| D2331 |
|
44 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
31 |
29 |
$409.76 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$131.78 |