| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,283 |
583 |
$114K |
| D0330 |
Panoramic radiographic image |
1,013 |
891 |
$64K |
| D1110 |
Prophylaxis - adult |
1,254 |
1,137 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,712 |
1,548 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,084 |
951 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,311 |
1,142 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
289 |
262 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
695 |
639 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
308 |
165 |
$25K |
| D1120 |
Prophylaxis - child |
575 |
508 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
660 |
592 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
146 |
98 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
670 |
598 |
$4K |
| D9945 |
|
17 |
17 |
$3K |
| D1351 |
Sealant - per tooth |
145 |
30 |
$3K |
| D0272 |
Bitewings - two radiographic images |
197 |
182 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
297 |
190 |
$1K |