| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
531 |
241 |
$29K |
| D1120 |
Prophylaxis - child |
749 |
679 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
937 |
836 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
698 |
631 |
$16K |
| D1351 |
Sealant - per tooth |
303 |
105 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
214 |
136 |
$12K |
| D0274 |
Bitewings - four radiographic images |
695 |
616 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
426 |
394 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
461 |
416 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,293 |
960 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,329 |
1,189 |
$7K |
| D1110 |
Prophylaxis - adult |
216 |
191 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
359 |
317 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
49 |
27 |
$4K |
| D4341 |
|
28 |
18 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
39 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
16 |
$2K |
| D0272 |
Bitewings - two radiographic images |
201 |
180 |
$2K |
| D0270 |
|
150 |
136 |
$784.00 |