| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
948 |
439 |
$56K |
| D5110 |
|
128 |
121 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,242 |
1,199 |
$33K |
| D5120 |
|
36 |
36 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
713 |
687 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
431 |
420 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
602 |
583 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
36 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
13 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
15 |
$914.85 |