| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,304 |
907 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
1,071 |
1,056 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
1,362 |
1,359 |
$39K |
| D1120 |
Prophylaxis - child |
779 |
779 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
425 |
237 |
$31K |
| D1206 |
Topical application of fluoride varnish |
763 |
763 |
$20K |
| D0274 |
Bitewings - four radiographic images |
924 |
921 |
$18K |
| D1110 |
Prophylaxis - adult |
317 |
317 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
217 |
142 |
$11K |
| D1351 |
Sealant - per tooth |
149 |
80 |
$11K |
| D4342 |
|
54 |
35 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,666 |
1,649 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
310 |
309 |
$8K |
| D0330 |
Panoramic radiographic image |
464 |
463 |
$7K |
| D2331 |
|
72 |
45 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
70 |
52 |
$7K |
| D4341 |
|
34 |
15 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,285 |
1,281 |
$6K |
| D2332 |
|
56 |
40 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
291 |
290 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
25 |
$5K |
| D2330 |
|
59 |
41 |
$4K |
| D9110 |
|
28 |
28 |
$1K |
| D0272 |
Bitewings - two radiographic images |
113 |
113 |
$1K |