| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
766 |
307 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
981 |
931 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,225 |
1,157 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
379 |
255 |
$22K |
| D1110 |
Prophylaxis - adult |
461 |
440 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
333 |
303 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
191 |
153 |
$14K |
| D0330 |
Panoramic radiographic image |
330 |
315 |
$12K |
| D1120 |
Prophylaxis - child |
308 |
302 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
327 |
319 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
347 |
322 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
522 |
491 |
$5K |
| D0274 |
Bitewings - four radiographic images |
99 |
97 |
$2K |
| D0272 |
Bitewings - two radiographic images |
47 |
47 |
$778.67 |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
17 |
$286.84 |
| D1330 |
|
1,235 |
1,180 |
$52.00 |
| D0603 |
|
974 |
906 |
$0.00 |
| D1310 |
|
405 |
390 |
$0.00 |
| D0602 |
|
13 |
13 |
$0.00 |