| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,391 |
460 |
$98K |
| D1351 |
Sealant - per tooth |
2,476 |
392 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
2,626 |
2,491 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,266 |
1,489 |
$35K |
| D1120 |
Prophylaxis - child |
832 |
824 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
800 |
738 |
$32K |
| D1110 |
Prophylaxis - adult |
399 |
393 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,001 |
993 |
$21K |
| D1320 |
|
1,082 |
1,072 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
614 |
610 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
139 |
103 |
$15K |
| D0330 |
Panoramic radiographic image |
236 |
233 |
$14K |
| D0272 |
Bitewings - two radiographic images |
563 |
557 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
79 |
$10K |
| D1206 |
Topical application of fluoride varnish |
341 |
337 |
$7K |
| D0274 |
Bitewings - four radiographic images |
166 |
163 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
174 |
170 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
13 |
$660.00 |