| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,137 |
371 |
$111K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
409 |
206 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
676 |
271 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
587 |
523 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
298 |
159 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
709 |
609 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
284 |
134 |
$18K |
| D1110 |
Prophylaxis - adult |
332 |
256 |
$17K |
| D7240 |
Removal of impacted tooth - completely bony |
43 |
13 |
$15K |
| D0330 |
Panoramic radiographic image |
207 |
156 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
449 |
351 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
242 |
195 |
$11K |
| D0274 |
Bitewings - four radiographic images |
263 |
203 |
$9K |
| D2332 |
|
52 |
28 |
$7K |
| D2335 |
|
35 |
13 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
398 |
330 |
$6K |
| D7250 |
|
22 |
12 |
$5K |
| D1351 |
Sealant - per tooth |
176 |
12 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
189 |
121 |
$4K |
| D2394 |
|
28 |
16 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
394 |
97 |
$2K |
| D1120 |
Prophylaxis - child |
22 |
13 |
$655.50 |