| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
141 |
44 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
146 |
81 |
$8K |
| D1110 |
Prophylaxis - adult |
237 |
224 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
296 |
271 |
$5K |
| D0272 |
Bitewings - two radiographic images |
251 |
234 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
128 |
112 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
46 |
$3K |
| D2140 |
|
74 |
49 |
$2K |
| D1206 |
Topical application of fluoride varnish |
147 |
139 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
143 |
123 |
$2K |
| D2160 |
|
21 |
18 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
60 |
54 |
$758.15 |
| D1120 |
Prophylaxis - child |
33 |
32 |
$722.00 |
| D0330 |
Panoramic radiographic image |
41 |
38 |
$376.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
52 |
36 |
$370.25 |
| D0602 |
|
26 |
26 |
$60.00 |
| D0603 |
|
35 |
34 |
$55.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19 |
19 |
$0.00 |