| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,658 |
1,600 |
$55K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
864 |
306 |
$48K |
| D0330 |
Panoramic radiographic image |
1,042 |
1,019 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,675 |
1,622 |
$39K |
| D1120 |
Prophylaxis - child |
744 |
732 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,313 |
2,222 |
$31K |
| D1206 |
Topical application of fluoride varnish |
770 |
748 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,937 |
1,960 |
$17K |
| D1351 |
Sealant - per tooth |
559 |
87 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
395 |
379 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
149 |
54 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
184 |
174 |
$5K |
| D1110 |
Prophylaxis - adult |
242 |
221 |
$4K |
| D0602 |
|
454 |
444 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
28 |
$2K |
| D0270 |
|
128 |
126 |
$1K |