| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,962 |
1,248 |
$178K |
| D1120 |
Prophylaxis - child |
6,282 |
4,651 |
$133K |
| D0140 |
Limited oral evaluation - problem focused |
3,485 |
2,883 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,793 |
2,467 |
$87K |
| D1206 |
Topical application of fluoride varnish |
4,898 |
3,558 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
502 |
250 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,072 |
1,678 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,821 |
1,617 |
$45K |
| D9310 |
|
861 |
833 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,032 |
1,726 |
$22K |
| D0330 |
Panoramic radiographic image |
360 |
322 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,385 |
775 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
15 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$3K |
| D1110 |
Prophylaxis - adult |
79 |
63 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
117 |
51 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
44 |
42 |
$459.79 |