| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,299 |
916 |
$96K |
| D0210 |
Intraoral - complete series of radiographic images |
1,529 |
1,494 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,867 |
1,815 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,798 |
1,778 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
468 |
269 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,869 |
1,819 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
627 |
621 |
$12K |
| D1110 |
Prophylaxis - adult |
265 |
257 |
$10K |
| D0180 |
|
1,150 |
1,142 |
$8K |
| D0330 |
Panoramic radiographic image |
147 |
146 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
83 |
52 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
170 |
99 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
621 |
373 |
$4K |
| D4355 |
|
82 |
76 |
$3K |
| D0274 |
Bitewings - four radiographic images |
136 |
135 |
$3K |
| D4341 |
|
29 |
13 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
66 |
39 |
$2K |
| D1120 |
Prophylaxis - child |
28 |
27 |
$1K |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$325.00 |
| D0190 |
|
15 |
15 |
$0.00 |
| D1330 |
|
26 |
26 |
$0.00 |