| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,395 |
664 |
$137K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
962 |
676 |
$107K |
| D1110 |
Prophylaxis - adult |
1,566 |
1,486 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
2,485 |
2,355 |
$76K |
| D0140 |
Limited oral evaluation - problem focused |
1,643 |
1,486 |
$70K |
| D1120 |
Prophylaxis - child |
1,596 |
1,498 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,438 |
2,314 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,412 |
1,334 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
617 |
587 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
360 |
272 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
146 |
120 |
$20K |
| D1351 |
Sealant - per tooth |
589 |
111 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,617 |
1,424 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
262 |
246 |
$13K |
| D1330 |
|
408 |
395 |
$4K |
| D0330 |
Panoramic radiographic image |
139 |
127 |
$4K |
| D0272 |
Bitewings - two radiographic images |
78 |
71 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
120 |
103 |
$2K |
| D4355 |
|
12 |
12 |
$993.88 |
| D1206 |
Topical application of fluoride varnish |
17 |
14 |
$279.71 |
| D0270 |
|
13 |
12 |
$89.28 |