| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,140 |
1,281 |
$334K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
923 |
240 |
$149K |
| D1206 |
Topical application of fluoride varnish |
5,313 |
5,215 |
$132K |
| D1120 |
Prophylaxis - child |
3,005 |
2,957 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
4,354 |
4,268 |
$124K |
| D1110 |
Prophylaxis - adult |
1,940 |
1,880 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
1,772 |
1,498 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
430 |
173 |
$55K |
| D1351 |
Sealant - per tooth |
686 |
99 |
$23K |
| D0274 |
Bitewings - four radiographic images |
970 |
938 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
369 |
351 |
$18K |
| D1330 |
|
2,222 |
2,177 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
36 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
34 |
27 |
$370.36 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
13 |
$118.08 |