| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,337 |
1,257 |
$183K |
| D1110 |
Prophylaxis - adult |
3,220 |
2,963 |
$105K |
| D0140 |
Limited oral evaluation - problem focused |
3,404 |
3,058 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
2,344 |
1,294 |
$61K |
| D0330 |
Panoramic radiographic image |
1,903 |
1,837 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
3,686 |
3,366 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,085 |
825 |
$57K |
| D0274 |
Bitewings - four radiographic images |
3,281 |
3,012 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,029 |
1,935 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
709 |
537 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,092 |
1,057 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,848 |
1,361 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
4,086 |
3,612 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
267 |
187 |
$15K |
| D1120 |
Prophylaxis - child |
594 |
557 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
102 |
80 |
$6K |
| D1206 |
Topical application of fluoride varnish |
428 |
339 |
$6K |
| D2335 |
|
51 |
41 |
$5K |
| D0350 |
|
376 |
353 |
$4K |
| D4342 |
|
42 |
14 |
$2K |
| D0270 |
|
448 |
417 |
$2K |
| D0272 |
Bitewings - two radiographic images |
184 |
183 |
$2K |
| D2332 |
|
19 |
15 |
$1K |
| D2331 |
|
18 |
12 |
$1K |
| D9995 |
|
22 |
21 |
$184.05 |
| D1999 |
|
28 |
28 |
$0.00 |