| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,604 |
506 |
$206K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,002 |
603 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,541 |
1,515 |
$85K |
| D1110 |
Prophylaxis - adult |
1,207 |
1,189 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
1,166 |
1,141 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,257 |
1,231 |
$59K |
| D1206 |
Topical application of fluoride varnish |
2,107 |
2,085 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
259 |
171 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
240 |
165 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
632 |
625 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,632 |
1,581 |
$18K |
| D1120 |
Prophylaxis - child |
199 |
197 |
$9K |
| D4341 |
|
92 |
36 |
$8K |
| D0274 |
Bitewings - four radiographic images |
320 |
318 |
$7K |
| D2950 |
|
84 |
62 |
$7K |
| D1351 |
Sealant - per tooth |
94 |
14 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
367 |
363 |
$3K |
| D0270 |
|
377 |
369 |
$3K |
| D1330 |
|
346 |
343 |
$2K |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$423.33 |