| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,713 |
710 |
$87K |
| D1110 |
Prophylaxis - adult |
1,860 |
1,793 |
$59K |
| D0330 |
Panoramic radiographic image |
1,250 |
1,183 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,282 |
2,176 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,702 |
1,609 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
691 |
433 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
2,000 |
1,937 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
523 |
370 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,296 |
2,420 |
$25K |
| D2394 |
|
202 |
160 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,841 |
2,674 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
862 |
836 |
$12K |
| D1120 |
Prophylaxis - child |
639 |
621 |
$12K |
| D1320 |
|
541 |
535 |
$8K |
| D2332 |
|
61 |
40 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
44 |
$3K |
| D0272 |
Bitewings - two radiographic images |
202 |
193 |
$2K |
| D2335 |
|
17 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$840.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
12 |
$780.00 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$519.34 |