| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,611 |
796 |
$154K |
| D0140 |
Limited oral evaluation - problem focused |
1,743 |
1,602 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,087 |
2,013 |
$61K |
| D1120 |
Prophylaxis - child |
1,528 |
1,470 |
$54K |
| D1110 |
Prophylaxis - adult |
719 |
687 |
$37K |
| D1351 |
Sealant - per tooth |
1,068 |
221 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,404 |
1,367 |
$24K |
| D0274 |
Bitewings - four radiographic images |
461 |
443 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,650 |
1,491 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
53 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
60 |
33 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
46 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
58 |
58 |
$4K |
| D0272 |
Bitewings - two radiographic images |
124 |
122 |
$3K |
| D0330 |
Panoramic radiographic image |
55 |
55 |
$3K |
| D1206 |
Topical application of fluoride varnish |
141 |
137 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$829.74 |
| D1330 |
|
27 |
27 |
$201.70 |
| D1310 |
|
27 |
27 |
$184.34 |