| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,037 |
1,004 |
$74K |
| D0330 |
Panoramic radiographic image |
1,296 |
1,284 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
756 |
478 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,055 |
1,048 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,008 |
1,004 |
$24K |
| D1120 |
Prophylaxis - child |
522 |
522 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
306 |
212 |
$20K |
| D1110 |
Prophylaxis - adult |
464 |
463 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
401 |
265 |
$18K |
| D0274 |
Bitewings - four radiographic images |
578 |
576 |
$13K |
| D1206 |
Topical application of fluoride varnish |
734 |
733 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
70 |
49 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
627 |
612 |
$5K |
| D0272 |
Bitewings - two radiographic images |
232 |
232 |
$4K |
| D1351 |
Sealant - per tooth |
184 |
69 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
36 |
26 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
92 |
92 |
$2K |
| D2335 |
|
18 |
12 |
$1K |
| D2332 |
|
17 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
202 |
144 |
$1K |