| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,402 |
844 |
$220K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,166 |
1,690 |
$190K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,618 |
952 |
$124K |
| D1110 |
Prophylaxis - adult |
2,653 |
2,393 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
3,967 |
3,620 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
1,570 |
1,334 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,838 |
1,657 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,986 |
1,805 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,417 |
1,255 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
934 |
585 |
$41K |
| D0330 |
Panoramic radiographic image |
1,061 |
929 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,671 |
1,543 |
$30K |
| D1120 |
Prophylaxis - child |
673 |
625 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,665 |
1,467 |
$16K |
| D2335 |
|
155 |
72 |
$16K |
| D2332 |
|
112 |
63 |
$11K |
| D1206 |
Topical application of fluoride varnish |
189 |
174 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
186 |
90 |
$958.00 |
| D0272 |
Bitewings - two radiographic images |
40 |
38 |
$702.12 |