| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,197 |
413 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,147 |
628 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
659 |
438 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
714 |
388 |
$36K |
| D0330 |
Panoramic radiographic image |
440 |
439 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
586 |
582 |
$15K |
| D1110 |
Prophylaxis - adult |
414 |
413 |
$14K |
| D2331 |
|
190 |
126 |
$12K |
| D2394 |
|
120 |
99 |
$9K |
| D2330 |
|
146 |
88 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
404 |
402 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
182 |
175 |
$6K |
| D0274 |
Bitewings - four radiographic images |
276 |
272 |
$5K |
| D2332 |
|
62 |
41 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
830 |
809 |
$4K |
| D0272 |
Bitewings - two radiographic images |
219 |
219 |
$2K |
| D2335 |
|
21 |
12 |
$2K |
| D2950 |
|
15 |
15 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
232 |
163 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
40 |
$903.20 |
| D1206 |
Topical application of fluoride varnish |
26 |
26 |
$390.00 |