| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
178 |
74 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
235 |
234 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
66 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
120 |
60 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
102 |
101 |
$5K |
| D1110 |
Prophylaxis - adult |
134 |
133 |
$4K |
| D1120 |
Prophylaxis - child |
202 |
202 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
234 |
234 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
177 |
177 |
$3K |
| D0274 |
Bitewings - four radiographic images |
130 |
130 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
367 |
361 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
341 |
300 |
$2K |
| D0272 |
Bitewings - two radiographic images |
81 |
81 |
$810.00 |
| D0140 |
Limited oral evaluation - problem focused |
75 |
72 |
$790.30 |