| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
597 |
221 |
$33K |
| D1110 |
Prophylaxis - adult |
556 |
523 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
844 |
794 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
202 |
190 |
$11K |
| D0274 |
Bitewings - four radiographic images |
260 |
246 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
51 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
127 |
126 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
155 |
141 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
98 |
97 |
$2K |
| D1120 |
Prophylaxis - child |
88 |
84 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
20 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
13 |
$1K |
| D1320 |
|
48 |
47 |
$705.00 |
| D0220 |
Intraoral - periapical first radiographic image |
139 |
137 |
$659.00 |
| D2140 |
|
15 |
14 |
$600.00 |
| D0272 |
Bitewings - two radiographic images |
31 |
31 |
$310.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
23 |
17 |
$105.00 |