| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,817 |
1,053 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,531 |
1,510 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,645 |
1,578 |
$28K |
| D1110 |
Prophylaxis - adult |
859 |
847 |
$27K |
| D0274 |
Bitewings - four radiographic images |
736 |
720 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
298 |
250 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,856 |
1,780 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
244 |
187 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
349 |
235 |
$3K |
| D0330 |
Panoramic radiographic image |
591 |
591 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
150 |
147 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
45 |
45 |
$914.76 |
| D0272 |
Bitewings - two radiographic images |
62 |
62 |
$598.05 |
| D1120 |
Prophylaxis - child |
14 |
14 |
$469.28 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$0.00 |
| D2330 |
|
19 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
236 |
208 |
$0.00 |