| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
886 |
487 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,418 |
1,345 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
641 |
623 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
357 |
274 |
$10K |
| D0330 |
Panoramic radiographic image |
251 |
243 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,499 |
1,434 |
$8K |
| D0274 |
Bitewings - four radiographic images |
507 |
487 |
$7K |
| D1110 |
Prophylaxis - adult |
180 |
167 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
68 |
44 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
433 |
245 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
69 |
63 |
$1K |
| D0190 |
|
140 |
136 |
$0.00 |