| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
791 |
323 |
$104K |
| D1110 |
Prophylaxis - adult |
1,113 |
1,064 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
744 |
705 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
1,382 |
1,295 |
$30K |
| D0274 |
Bitewings - four radiographic images |
570 |
548 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
648 |
622 |
$25K |
| D0330 |
Panoramic radiographic image |
228 |
217 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
882 |
493 |
$18K |
| D2330 |
|
190 |
92 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
91 |
91 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
43 |
$5K |
| D9410 |
|
36 |
36 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D2331 |
|
13 |
12 |
$2K |