| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,253 |
951 |
$178K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,103 |
2,091 |
$160K |
| D1110 |
Prophylaxis - adult |
2,241 |
2,231 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
831 |
646 |
$96K |
| D0140 |
Limited oral evaluation - problem focused |
1,241 |
1,206 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
1,623 |
1,623 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
1,357 |
1,340 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
414 |
322 |
$40K |
| D0274 |
Bitewings - four radiographic images |
878 |
877 |
$22K |
| D1120 |
Prophylaxis - child |
452 |
451 |
$18K |
| D1206 |
Topical application of fluoride varnish |
708 |
706 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,344 |
1,328 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
50 |
25 |
$7K |
| D1351 |
Sealant - per tooth |
278 |
29 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
28 |
$4K |
| D2950 |
|
29 |
28 |
$4K |
| D4341 |
|
25 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
322 |
227 |
$2K |
| D2332 |
|
18 |
13 |
$2K |
| D0270 |
|
13 |
13 |
$129.52 |
| D0603 |
|
53 |
53 |
$0.00 |