| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
301 |
162 |
$18K |
| D1110 |
Prophylaxis - adult |
462 |
457 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
528 |
522 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
270 |
265 |
$9K |
| D0274 |
Bitewings - four radiographic images |
211 |
206 |
$6K |
| D1206 |
Topical application of fluoride varnish |
191 |
187 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
401 |
386 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
39 |
$3K |
| D1120 |
Prophylaxis - child |
89 |
86 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
72 |
70 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
18 |
$810.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
15 |
$176.00 |