| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,745 |
1,196 |
$249K |
| D0140 |
Limited oral evaluation - problem focused |
5,749 |
4,590 |
$182K |
| D0330 |
Panoramic radiographic image |
4,523 |
3,735 |
$164K |
| D1120 |
Prophylaxis - child |
4,954 |
4,057 |
$116K |
| D1206 |
Topical application of fluoride varnish |
4,324 |
3,596 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
2,894 |
2,525 |
$69K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
677 |
318 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,981 |
1,500 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
888 |
271 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,385 |
1,094 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
380 |
144 |
$27K |
| D1351 |
Sealant - per tooth |
440 |
65 |
$11K |
| D8670 |
Periodic orthodontic treatment visit |
98 |
79 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
863 |
651 |
$8K |
| D0272 |
Bitewings - two radiographic images |
572 |
399 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
250 |
58 |
$4K |
| D0470 |
|
34 |
32 |
$1K |
| D0340 |
|
30 |
25 |
$1K |
| D0350 |
|
37 |
35 |
$846.71 |
| D1208 |
Topical application of fluoride, excluding varnish |
22 |
16 |
$321.04 |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
15 |
$189.24 |
| D9110 |
|
24 |
19 |
$0.00 |