| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,855 |
863 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,278 |
715 |
$68K |
| D1110 |
Prophylaxis - adult |
1,713 |
1,681 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
843 |
764 |
$42K |
| D0330 |
Panoramic radiographic image |
883 |
857 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
2,355 |
2,314 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,408 |
1,381 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
540 |
396 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,686 |
1,651 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
393 |
251 |
$19K |
| D1120 |
Prophylaxis - child |
764 |
756 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,003 |
987 |
$15K |
| D2335 |
|
123 |
65 |
$11K |
| D2394 |
|
130 |
99 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,446 |
1,408 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
15 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,249 |
1,059 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
266 |
256 |
$5K |
| D1351 |
Sealant - per tooth |
142 |
34 |
$3K |
| D0272 |
Bitewings - two radiographic images |
329 |
324 |
$3K |