| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,828 |
669 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
951 |
942 |
$51K |
| D1110 |
Prophylaxis - adult |
1,345 |
1,339 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,600 |
1,590 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
613 |
281 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,027 |
1,025 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
332 |
184 |
$17K |
| D0274 |
Bitewings - four radiographic images |
887 |
883 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
560 |
542 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
769 |
766 |
$11K |
| D1120 |
Prophylaxis - child |
541 |
540 |
$11K |
| D2335 |
|
98 |
45 |
$8K |
| D1351 |
Sealant - per tooth |
378 |
98 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
106 |
68 |
$6K |
| D2332 |
|
68 |
27 |
$3K |
| D2394 |
|
36 |
27 |
$2K |
| D1206 |
Topical application of fluoride varnish |
136 |
136 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
368 |
359 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
213 |
187 |
$980.00 |
| D0272 |
Bitewings - two radiographic images |
49 |
49 |
$480.00 |
| D0250 |
|
13 |
13 |
$174.98 |