| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
267 |
142 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
462 |
452 |
$8K |
| D0274 |
Bitewings - four radiographic images |
366 |
356 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,394 |
510 |
$7K |
| D1110 |
Prophylaxis - adult |
190 |
187 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
93 |
51 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
731 |
715 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
30 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
111 |
108 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
126 |
125 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
73 |
72 |
$2K |
| D2394 |
|
22 |
15 |
$2K |
| D1120 |
Prophylaxis - child |
69 |
68 |
$1K |
| D0240 |
|
92 |
46 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$130.00 |