| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,650 |
991 |
$99K |
| D1110 |
Prophylaxis - adult |
2,471 |
2,323 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
3,483 |
3,305 |
$82K |
| D0330 |
Panoramic radiographic image |
1,166 |
1,104 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,746 |
1,617 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,539 |
3,242 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,623 |
1,509 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,120 |
2,022 |
$33K |
| D1120 |
Prophylaxis - child |
1,236 |
1,156 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,625 |
2,348 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
195 |
144 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
342 |
307 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
162 |
109 |
$12K |
| D0272 |
Bitewings - two radiographic images |
703 |
639 |
$12K |
| D2940 |
|
181 |
129 |
$7K |
| D9110 |
|
109 |
97 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
16 |
$3K |
| D0170 |
|
90 |
86 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
155 |
110 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$1K |
| D4346 |
|
13 |
13 |
$514.78 |