| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
464 |
170 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
382 |
366 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
203 |
131 |
$18K |
| D1110 |
Prophylaxis - adult |
380 |
380 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
439 |
439 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
394 |
393 |
$8K |
| D1120 |
Prophylaxis - child |
210 |
209 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
622 |
341 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
537 |
535 |
$6K |
| D0274 |
Bitewings - four radiographic images |
185 |
185 |
$5K |
| D1206 |
Topical application of fluoride varnish |
214 |
214 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
174 |
174 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
27 |
$3K |
| D1351 |
Sealant - per tooth |
77 |
19 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
15 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
76 |
75 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$785.85 |
| D1999 |
|
14 |
13 |
$0.00 |