| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,195 |
516 |
$65K |
| D1110 |
Prophylaxis - adult |
1,753 |
1,667 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
789 |
743 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
2,427 |
2,307 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
754 |
450 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
680 |
370 |
$31K |
| D0274 |
Bitewings - four radiographic images |
912 |
867 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
276 |
194 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,087 |
1,040 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
626 |
588 |
$15K |
| D1120 |
Prophylaxis - child |
725 |
685 |
$13K |
| D2331 |
|
150 |
96 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
289 |
272 |
$6K |
| D1351 |
Sealant - per tooth |
245 |
46 |
$5K |
| D2335 |
|
37 |
27 |
$3K |
| D2330 |
|
37 |
25 |
$2K |
| D1320 |
|
106 |
105 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
234 |
230 |
$1K |
| D0272 |
Bitewings - two radiographic images |
53 |
50 |
$480.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
47 |
25 |
$235.00 |