| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
443 |
96 |
$14K |
| D1110 |
Prophylaxis - adult |
331 |
309 |
$14K |
| D0330 |
Panoramic radiographic image |
470 |
261 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
578 |
375 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
135 |
46 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
72 |
34 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
331 |
210 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
43 |
$4K |
| D0274 |
Bitewings - four radiographic images |
251 |
240 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
152 |
148 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
427 |
256 |
$3K |
| D1120 |
Prophylaxis - child |
80 |
80 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
55 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
100 |
100 |
$2K |
| D1351 |
Sealant - per tooth |
41 |
12 |
$1K |
| D9630 |
|
15 |
13 |
$258.31 |
| D1999 |
|
164 |
156 |
$0.00 |