| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7971 |
|
113 |
109 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,225 |
1,145 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
350 |
87 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
362 |
121 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,306 |
698 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
728 |
716 |
$15K |
| D0274 |
Bitewings - four radiographic images |
424 |
418 |
$13K |
| D2332 |
|
105 |
44 |
$12K |
| D1110 |
Prophylaxis - adult |
363 |
359 |
$12K |
| D1120 |
Prophylaxis - child |
249 |
245 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
829 |
769 |
$10K |
| D2335 |
|
72 |
40 |
$9K |
| D0330 |
Panoramic radiographic image |
376 |
366 |
$9K |
| D1351 |
Sealant - per tooth |
207 |
47 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
277 |
272 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
99 |
99 |
$5K |
| D2140 |
|
30 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
47 |
36 |
$497.64 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$420.16 |