| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,713 |
537 |
$140K |
| D1110 |
Prophylaxis - adult |
2,596 |
2,433 |
$130K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
536 |
356 |
$66K |
| D1206 |
Topical application of fluoride varnish |
2,532 |
2,390 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,169 |
1,003 |
$41K |
| D0330 |
Panoramic radiographic image |
592 |
562 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
688 |
636 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
312 |
218 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
911 |
851 |
$24K |
| D0274 |
Bitewings - four radiographic images |
712 |
664 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,036 |
920 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
67 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
187 |
133 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
31 |
$8K |
| D4355 |
|
43 |
43 |
$3K |
| D1354 |
|
134 |
58 |
$3K |
| D2950 |
|
15 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
46 |
40 |
$2K |
| D2330 |
|
16 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
134 |
64 |
$931.00 |