| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,333 |
551 |
$169K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,920 |
972 |
$131K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
602 |
422 |
$110K |
| D0330 |
Panoramic radiographic image |
1,227 |
1,224 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
505 |
505 |
$60K |
| D1110 |
Prophylaxis - adult |
844 |
844 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
684 |
432 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
548 |
516 |
$14K |
| D4910 |
|
92 |
92 |
$10K |
| D4341 |
|
130 |
36 |
$8K |
| D2331 |
|
105 |
69 |
$4K |
| D1120 |
Prophylaxis - child |
73 |
73 |
$3K |
| D2332 |
|
29 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,702 |
1,701 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,089 |
1,087 |
$1K |
| D4346 |
|
15 |
15 |
$995.96 |
| D2330 |
|
44 |
28 |
$682.03 |
| D0220 |
Intraoral - periapical first radiographic image |
1,033 |
1,024 |
$22.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
940 |
775 |
$21.17 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,015 |
1,015 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
805 |
805 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
47 |
47 |
$0.00 |