| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
835 |
543 |
$53K |
| D1120 |
Prophylaxis - child |
979 |
875 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,140 |
998 |
$31K |
| D1110 |
Prophylaxis - adult |
782 |
725 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,186 |
1,075 |
$23K |
| D1351 |
Sealant - per tooth |
269 |
135 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
291 |
215 |
$19K |
| D0274 |
Bitewings - four radiographic images |
1,119 |
1,011 |
$17K |
| D1206 |
Topical application of fluoride varnish |
459 |
424 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
463 |
399 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,435 |
1,296 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
707 |
612 |
$6K |
| D0272 |
Bitewings - two radiographic images |
486 |
427 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
42 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
205 |
190 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$709.55 |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
30 |
$394.60 |
| D1999 |
|
396 |
287 |
$0.00 |