| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,061 |
681 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,624 |
2,672 |
$114K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,358 |
671 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
2,866 |
2,045 |
$104K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,413 |
695 |
$96K |
| D1110 |
Prophylaxis - adult |
2,428 |
1,907 |
$83K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,296 |
546 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
1,926 |
1,613 |
$40K |
| D2394 |
|
278 |
149 |
$24K |
| D1120 |
Prophylaxis - child |
579 |
565 |
$17K |
| D0272 |
Bitewings - two radiographic images |
459 |
427 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
468 |
455 |
$9K |
| D0330 |
Panoramic radiographic image |
655 |
435 |
$8K |
| D2332 |
|
41 |
16 |
$3K |
| D0274 |
Bitewings - four radiographic images |
112 |
100 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
87 |
65 |
$864.13 |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$495.77 |
| D0140 |
Limited oral evaluation - problem focused |
34 |
24 |
$391.06 |