| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
748 |
320 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
274 |
164 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
200 |
125 |
$7K |
| D1120 |
Prophylaxis - child |
180 |
167 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
361 |
320 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
94 |
70 |
$6K |
| D1110 |
Prophylaxis - adult |
178 |
161 |
$5K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
17 |
14 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
179 |
165 |
$4K |
| D0274 |
Bitewings - four radiographic images |
254 |
229 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
143 |
132 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
602 |
520 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
193 |
173 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
361 |
276 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
30 |
$3K |
| D2330 |
|
51 |
33 |
$2K |
| D0272 |
Bitewings - two radiographic images |
49 |
40 |
$394.80 |
| D0270 |
|
13 |
13 |
$72.80 |