| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,278 |
375 |
$72K |
| D1110 |
Prophylaxis - adult |
1,343 |
1,189 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
855 |
435 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
2,329 |
1,989 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
755 |
745 |
$44K |
| D2394 |
|
536 |
324 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
570 |
318 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,032 |
1,015 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,144 |
987 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,331 |
1,182 |
$20K |
| D1120 |
Prophylaxis - child |
628 |
566 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
119 |
65 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,137 |
1,006 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
215 |
208 |
$5K |
| D2335 |
|
45 |
24 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$65.00 |