| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,358 |
571 |
$135K |
| D0330 |
Panoramic radiographic image |
1,728 |
1,670 |
$81K |
| D1110 |
Prophylaxis - adult |
1,795 |
1,753 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
881 |
516 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,268 |
1,228 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
474 |
114 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,425 |
1,390 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,045 |
1,636 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
730 |
700 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
212 |
153 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
703 |
701 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,171 |
2,068 |
$11K |
| D2950 |
|
117 |
88 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
123 |
91 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
420 |
405 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
114 |
66 |
$6K |
| D1206 |
Topical application of fluoride varnish |
335 |
332 |
$6K |
| D2394 |
|
59 |
37 |
$4K |
| D1120 |
Prophylaxis - child |
168 |
168 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
661 |
221 |
$3K |
| D2140 |
|
34 |
24 |
$1K |
| D0272 |
Bitewings - two radiographic images |
110 |
108 |
$1K |
| D2160 |
|
19 |
16 |
$1K |
| D2332 |
|
15 |
12 |
$1K |
| D0180 |
|
13 |
13 |
$342.55 |