| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,017 |
337 |
$66K |
| D1110 |
Prophylaxis - adult |
1,077 |
1,061 |
$44K |
| D0330 |
Panoramic radiographic image |
837 |
682 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,036 |
893 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,395 |
1,388 |
$25K |
| D0274 |
Bitewings - four radiographic images |
862 |
851 |
$20K |
| D1120 |
Prophylaxis - child |
527 |
520 |
$17K |
| D1206 |
Topical application of fluoride varnish |
812 |
803 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
618 |
515 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
137 |
91 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
569 |
361 |
$8K |
| D4910 |
|
140 |
137 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
711 |
499 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
39 |
$5K |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$876.65 |
| D4341 |
|
44 |
12 |
$372.56 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$249.48 |
| D0230 |
Intraoral - periapical each additional radiographic image |
23 |
14 |
$134.16 |