| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,107 |
1,316 |
$211K |
| D0140 |
Limited oral evaluation - problem focused |
2,520 |
2,395 |
$121K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
193 |
132 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,320 |
2,147 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
408 |
399 |
$17K |
| D0330 |
Panoramic radiographic image |
826 |
804 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
74 |
63 |
$4K |
| D0270 |
|
1,210 |
1,175 |
$4K |
| D0274 |
Bitewings - four radiographic images |
295 |
287 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
85 |
83 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
111 |
111 |
$1K |
| D2950 |
|
17 |
13 |
$510.88 |
| D1110 |
Prophylaxis - adult |
16 |
16 |
$406.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$13.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
14 |
$0.00 |