| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
674 |
312 |
$34K |
| D1110 |
Prophylaxis - adult |
877 |
868 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
886 |
875 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
845 |
780 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
546 |
487 |
$13K |
| D1206 |
Topical application of fluoride varnish |
920 |
910 |
$13K |
| D0274 |
Bitewings - four radiographic images |
671 |
662 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
761 |
752 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
194 |
109 |
$10K |
| D0330 |
Panoramic radiographic image |
277 |
273 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
158 |
96 |
$10K |
| D2394 |
|
88 |
56 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,285 |
1,233 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
953 |
877 |
$4K |
| D1120 |
Prophylaxis - child |
133 |
127 |
$2K |