| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
796 |
473 |
$45K |
| D1110 |
Prophylaxis - adult |
702 |
702 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
986 |
972 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
398 |
306 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,067 |
1,067 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
399 |
398 |
$11K |
| D1206 |
Topical application of fluoride varnish |
586 |
585 |
$9K |
| D1120 |
Prophylaxis - child |
371 |
371 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,436 |
1,410 |
$7K |
| D0274 |
Bitewings - four radiographic images |
348 |
348 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,075 |
450 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
66 |
$5K |
| D0330 |
Panoramic radiographic image |
56 |
56 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
43 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
169 |
169 |
$2K |
| D1354 |
|
69 |
28 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
14 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$481.79 |