| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,495 |
535 |
$70K |
| D1110 |
Prophylaxis - adult |
1,273 |
1,250 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
527 |
406 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,476 |
1,408 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
653 |
590 |
$20K |
| D1120 |
Prophylaxis - child |
849 |
845 |
$18K |
| D1351 |
Sealant - per tooth |
655 |
211 |
$18K |
| D0274 |
Bitewings - four radiographic images |
998 |
991 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
1,276 |
1,263 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
268 |
187 |
$13K |
| D1206 |
Topical application of fluoride varnish |
930 |
924 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
56 |
$6K |
| D0330 |
Panoramic radiographic image |
265 |
265 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
51 |
$2K |
| D2330 |
|
36 |
24 |
$1K |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$322.40 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$0.00 |