| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,330 |
2,042 |
$237K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,786 |
1,979 |
$197K |
| D1110 |
Prophylaxis - adult |
4,425 |
4,334 |
$181K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,062 |
4,953 |
$133K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,178 |
1,442 |
$131K |
| D2335 |
|
1,755 |
812 |
$127K |
| D0274 |
Bitewings - four radiographic images |
4,467 |
4,368 |
$101K |
| D0330 |
Panoramic radiographic image |
2,492 |
2,449 |
$92K |
| D2330 |
|
2,065 |
781 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,912 |
994 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,835 |
2,439 |
$47K |
| D2332 |
|
726 |
473 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
4,310 |
4,153 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
354 |
259 |
$24K |
| D2394 |
|
322 |
243 |
$23K |
| D2331 |
|
362 |
247 |
$18K |
| D9110 |
|
408 |
349 |
$8K |
| D1120 |
Prophylaxis - child |
37 |
37 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
37 |
37 |
$598.65 |
| D9986 |
|
1,320 |
1,149 |
$0.00 |
| D9987 |
|
172 |
142 |
$0.00 |