| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
394 |
192 |
$26K |
| D1110 |
Prophylaxis - adult |
353 |
349 |
$12K |
| D0274 |
Bitewings - four radiographic images |
461 |
436 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
141 |
83 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
344 |
335 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
224 |
221 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
522 |
488 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
490 |
443 |
$4K |
| D0330 |
Panoramic radiographic image |
121 |
117 |
$3K |
| D9110 |
|
94 |
90 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
17 |
$1K |