| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,513 |
425 |
$83K |
| D1110 |
Prophylaxis - adult |
1,994 |
1,955 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,217 |
1,197 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,238 |
609 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
905 |
549 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,497 |
1,460 |
$33K |
| D5110 |
|
38 |
38 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,656 |
1,628 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
202 |
158 |
$17K |
| D1206 |
Topical application of fluoride varnish |
996 |
988 |
$16K |
| D4341 |
|
268 |
128 |
$15K |
| D1120 |
Prophylaxis - child |
538 |
534 |
$15K |
| D0274 |
Bitewings - four radiographic images |
768 |
759 |
$14K |
| D1351 |
Sealant - per tooth |
477 |
115 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,381 |
1,351 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
715 |
690 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,016 |
548 |
$12K |
| D5120 |
|
12 |
12 |
$10K |
| D0272 |
Bitewings - two radiographic images |
49 |
48 |
$943.20 |
| D4910 |
|
13 |
13 |
$887.92 |
| D2330 |
|
50 |
24 |
$0.00 |
| D2331 |
|
66 |
26 |
$0.00 |