| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,187 |
839 |
$137K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
629 |
440 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,671 |
1,511 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,240 |
1,144 |
$49K |
| D0330 |
Panoramic radiographic image |
1,031 |
935 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,233 |
2,911 |
$45K |
| D1110 |
Prophylaxis - adult |
901 |
851 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,109 |
1,025 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,898 |
1,601 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
705 |
669 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
160 |
110 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
143 |
92 |
$11K |
| D4355 |
|
123 |
115 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
378 |
355 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
15 |
$2K |
| D1120 |
Prophylaxis - child |
41 |
38 |
$996.10 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$212.85 |