| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,634 |
989 |
$157K |
| D0330 |
Panoramic radiographic image |
2,194 |
2,086 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,579 |
791 |
$80K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,236 |
711 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,095 |
1,992 |
$57K |
| D1110 |
Prophylaxis - adult |
1,304 |
1,220 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,831 |
1,736 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,036 |
964 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
179 |
126 |
$17K |
| D2332 |
|
269 |
146 |
$16K |
| D5110 |
|
29 |
27 |
$16K |
| D1120 |
Prophylaxis - child |
261 |
244 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
2,458 |
2,001 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
25 |
17 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
505 |
463 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
559 |
529 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,496 |
755 |
$6K |
| D3320 |
|
19 |
14 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
52 |
$3K |
| D2335 |
|
19 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
16 |
15 |
$187.04 |