| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,202 |
477 |
$32K |
| D1110 |
Prophylaxis - adult |
1,110 |
974 |
$32K |
| D0330 |
Panoramic radiographic image |
756 |
665 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,226 |
1,082 |
$18K |
| D1120 |
Prophylaxis - child |
366 |
335 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
566 |
458 |
$12K |
| D0274 |
Bitewings - four radiographic images |
650 |
574 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
398 |
364 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
162 |
95 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
110 |
67 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
750 |
598 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
80 |
75 |
$909.64 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$75.30 |