| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,941 |
653 |
$203K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
523 |
260 |
$34K |
| D1110 |
Prophylaxis - adult |
908 |
891 |
$31K |
| D0330 |
Panoramic radiographic image |
732 |
719 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,082 |
1,054 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,101 |
1,087 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
370 |
194 |
$19K |
| D0272 |
Bitewings - two radiographic images |
908 |
895 |
$14K |
| D0274 |
Bitewings - four radiographic images |
487 |
474 |
$13K |
| D1206 |
Topical application of fluoride varnish |
446 |
440 |
$8K |
| D1120 |
Prophylaxis - child |
199 |
198 |
$6K |
| D1330 |
|
425 |
419 |
$4K |
| D1310 |
|
415 |
409 |
$4K |
| D2331 |
|
54 |
37 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
26 |
$2K |
| D1351 |
Sealant - per tooth |
84 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
258 |
247 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$621.24 |
| D2330 |
|
17 |
12 |
$612.90 |
| D1999 |
|
59 |
55 |
$217.00 |