| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
894 |
235 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
311 |
171 |
$19K |
| D0330 |
Panoramic radiographic image |
487 |
484 |
$18K |
| D1110 |
Prophylaxis - adult |
500 |
497 |
$17K |
| D0274 |
Bitewings - four radiographic images |
529 |
524 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
555 |
551 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
476 |
471 |
$9K |
| D1351 |
Sealant - per tooth |
303 |
36 |
$8K |
| D1206 |
Topical application of fluoride varnish |
377 |
375 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
106 |
70 |
$7K |
| D1120 |
Prophylaxis - child |
183 |
183 |
$6K |
| D2332 |
|
76 |
43 |
$5K |
| D1330 |
|
378 |
377 |
$4K |
| D1310 |
|
379 |
378 |
$4K |
| D9110 |
|
121 |
117 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
41 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
337 |
327 |
$2K |
| D0272 |
Bitewings - two radiographic images |
85 |
85 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34 |
25 |
$248.15 |
| D1999 |
|
14 |
13 |
$63.00 |