| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
848 |
358 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
594 |
390 |
$69K |
| D1110 |
Prophylaxis - adult |
1,257 |
1,212 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
584 |
548 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
897 |
856 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
624 |
588 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,125 |
1,088 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
230 |
142 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
106 |
86 |
$16K |
| D0274 |
Bitewings - four radiographic images |
327 |
321 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
532 |
505 |
$9K |
| D0330 |
Panoramic radiographic image |
155 |
147 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
199 |
195 |
$5K |
| D4341 |
|
24 |
13 |
$3K |
| D1120 |
Prophylaxis - child |
55 |
54 |
$2K |
| D4355 |
|
13 |
12 |
$1K |