| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
927 |
290 |
$65K |
| D0330 |
Panoramic radiographic image |
758 |
728 |
$47K |
| D1110 |
Prophylaxis - adult |
888 |
855 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
592 |
379 |
$34K |
| D0274 |
Bitewings - four radiographic images |
846 |
821 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
787 |
761 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
171 |
75 |
$23K |
| D1120 |
Prophylaxis - child |
352 |
340 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
736 |
715 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,841 |
645 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
295 |
283 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,049 |
1,008 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
210 |
160 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
461 |
453 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
63 |
$6K |
| D0272 |
Bitewings - two radiographic images |
74 |
74 |
$2K |
| D2335 |
|
17 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
70 |
70 |
$1K |