| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,379 |
692 |
$47K |
| D1110 |
Prophylaxis - adult |
1,248 |
1,196 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
695 |
449 |
$33K |
| D0330 |
Panoramic radiographic image |
986 |
926 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,394 |
1,336 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
857 |
819 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
471 |
319 |
$17K |
| D1120 |
Prophylaxis - child |
424 |
408 |
$17K |
| D0274 |
Bitewings - four radiographic images |
597 |
570 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
803 |
774 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
544 |
530 |
$10K |
| D0272 |
Bitewings - two radiographic images |
701 |
669 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
924 |
871 |
$5K |
| D2331 |
|
38 |
24 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
281 |
258 |
$895.65 |