| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
1,108 |
619 |
$222K |
| D1120 |
Prophylaxis - child |
2,263 |
1,600 |
$95K |
| D1206 |
Topical application of fluoride varnish |
2,531 |
1,789 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
568 |
295 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,435 |
1,313 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,650 |
1,254 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
745 |
425 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
580 |
308 |
$32K |
| D1351 |
Sealant - per tooth |
1,312 |
287 |
$26K |
| D0274 |
Bitewings - four radiographic images |
800 |
547 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
526 |
385 |
$16K |
| D0330 |
Panoramic radiographic image |
286 |
231 |
$14K |
| D7230 |
|
75 |
48 |
$13K |
| D1110 |
Prophylaxis - adult |
318 |
219 |
$13K |
| D7220 |
|
66 |
50 |
$9K |
| D7111 |
|
166 |
86 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
669 |
459 |
$8K |
| D0272 |
Bitewings - two radiographic images |
363 |
253 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
60 |
34 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
399 |
276 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
53 |
27 |
$3K |
| T1015 |
Clinic visit/encounter, all-inclusive |
14 |
12 |
$2K |
| D2140 |
|
37 |
24 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
21 |
15 |
$581.70 |
| D2940 |
|
16 |
12 |
$560.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
19 |
15 |
$484.50 |