| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,371 |
601 |
$88K |
| D1120 |
Prophylaxis - child |
1,333 |
1,262 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,763 |
632 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,676 |
1,562 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
835 |
422 |
$38K |
| D1351 |
Sealant - per tooth |
1,101 |
304 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,326 |
1,255 |
$32K |
| D1110 |
Prophylaxis - adult |
699 |
625 |
$28K |
| D0330 |
Panoramic radiographic image |
957 |
895 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
312 |
86 |
$17K |
| D2332 |
|
267 |
133 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
587 |
538 |
$12K |
| D0272 |
Bitewings - two radiographic images |
858 |
795 |
$6K |
| D2330 |
|
201 |
83 |
$6K |
| D5110 |
|
13 |
13 |
$5K |
| D2331 |
|
103 |
60 |
$5K |
| D0274 |
Bitewings - four radiographic images |
296 |
277 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
280 |
251 |
$4K |
| D9110 |
|
79 |
70 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
268 |
251 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
117 |
114 |
$946.10 |
| D0230 |
Intraoral - periapical each additional radiographic image |
37 |
28 |
$182.40 |