| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,405 |
1,443 |
$228K |
| D1110 |
Prophylaxis - adult |
4,545 |
4,313 |
$204K |
| D0120 |
Periodic oral evaluation - established patient |
5,636 |
5,470 |
$148K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,632 |
1,116 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,154 |
1,888 |
$87K |
| D1120 |
Prophylaxis - child |
2,590 |
2,565 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,178 |
3,146 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
1,236 |
1,086 |
$58K |
| D0272 |
Bitewings - two radiographic images |
2,775 |
2,726 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
818 |
513 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,468 |
1,359 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
4,519 |
3,798 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
278 |
211 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,053 |
2,170 |
$16K |
| D0330 |
Panoramic radiographic image |
90 |
83 |
$4K |
| D0274 |
Bitewings - four radiographic images |
86 |
80 |
$2K |
| D1206 |
Topical application of fluoride varnish |
64 |
61 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$461.88 |