| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
454 |
213 |
$23K |
| D1110 |
Prophylaxis - adult |
768 |
713 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
383 |
374 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
794 |
709 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
228 |
88 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
761 |
667 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
160 |
85 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
560 |
455 |
$6K |
| D1120 |
Prophylaxis - child |
350 |
275 |
$5K |
| D0274 |
Bitewings - four radiographic images |
279 |
255 |
$4K |
| D0330 |
Panoramic radiographic image |
168 |
90 |
$3K |
| D1351 |
Sealant - per tooth |
130 |
29 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
603 |
497 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
463 |
373 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
64 |
30 |
$618.17 |
| D0272 |
Bitewings - two radiographic images |
28 |
16 |
$30.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
381 |
281 |
$0.00 |