| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,376 |
691 |
$100K |
| D0140 |
Limited oral evaluation - problem focused |
2,019 |
1,756 |
$68K |
| D1110 |
Prophylaxis - adult |
910 |
837 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,039 |
686 |
$42K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
317 |
185 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,344 |
1,521 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
904 |
758 |
$22K |
| D1120 |
Prophylaxis - child |
558 |
467 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
869 |
727 |
$19K |
| D1351 |
Sealant - per tooth |
529 |
54 |
$17K |
| D0330 |
Panoramic radiographic image |
266 |
244 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
160 |
126 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
230 |
146 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
96 |
92 |
$7K |
| D9630 |
|
318 |
302 |
$6K |
| D1320 |
|
217 |
209 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
139 |
131 |
$5K |
| D2330 |
|
73 |
37 |
$4K |
| D0274 |
Bitewings - four radiographic images |
129 |
124 |
$4K |
| D2335 |
|
26 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
95 |
94 |
$2K |
| D0270 |
|
68 |
64 |
$1K |
| D0272 |
Bitewings - two radiographic images |
15 |
13 |
$412.50 |