| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,727 |
1,426 |
$176K |
| D1110 |
Prophylaxis - adult |
3,151 |
3,139 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,023 |
625 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
3,837 |
3,824 |
$72K |
| D2394 |
|
574 |
456 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,829 |
1,825 |
$50K |
| D1120 |
Prophylaxis - child |
1,179 |
1,177 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
664 |
417 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
904 |
900 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,004 |
2,002 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,217 |
1,215 |
$28K |
| D5110 |
|
45 |
45 |
$21K |
| D0330 |
Panoramic radiographic image |
608 |
607 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
239 |
202 |
$16K |
| D5120 |
|
32 |
32 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
203 |
166 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
649 |
638 |
$6K |
| D2335 |
|
65 |
50 |
$5K |
| D2332 |
|
54 |
39 |
$3K |
| D1352 |
|
41 |
12 |
$3K |
| D2331 |
|
30 |
14 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
66 |
66 |
$2K |
| D7310 |
|
27 |
15 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
234 |
162 |
$1K |
| D0274 |
Bitewings - four radiographic images |
39 |
38 |
$651.78 |
| D2330 |
|
17 |
12 |
$500.30 |