| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
566 |
341 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,030 |
962 |
$28K |
| D1120 |
Prophylaxis - child |
674 |
656 |
$27K |
| D1110 |
Prophylaxis - adult |
561 |
543 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,112 |
1,042 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
291 |
218 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
626 |
608 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
696 |
656 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
267 |
198 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,810 |
1,667 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,624 |
1,432 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
261 |
242 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
67 |
43 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
267 |
251 |
$4K |
| D0272 |
Bitewings - two radiographic images |
86 |
84 |
$780.20 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$658.35 |
| D0270 |
|
46 |
44 |
$244.60 |
| D1999 |
|
452 |
411 |
$0.00 |