| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,411 |
566 |
$94K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
738 |
446 |
$85K |
| D0274 |
Bitewings - four radiographic images |
2,386 |
2,376 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
2,183 |
2,142 |
$66K |
| D2394 |
|
564 |
407 |
$61K |
| D1110 |
Prophylaxis - adult |
1,308 |
1,306 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,629 |
1,623 |
$58K |
| D0330 |
Panoramic radiographic image |
1,191 |
1,190 |
$50K |
| D1120 |
Prophylaxis - child |
1,456 |
1,448 |
$48K |
| D1206 |
Topical application of fluoride varnish |
1,405 |
1,401 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,099 |
1,092 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
358 |
252 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,378 |
1,358 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
153 |
116 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
484 |
468 |
$9K |
| D0272 |
Bitewings - two radiographic images |
212 |
211 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
51 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
95 |
79 |
$957.13 |