| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
134 |
47 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
512 |
512 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
184 |
66 |
$25K |
| D1110 |
Prophylaxis - adult |
302 |
302 |
$20K |
| D0330 |
Panoramic radiographic image |
370 |
370 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
154 |
62 |
$17K |
| D1206 |
Topical application of fluoride varnish |
458 |
458 |
$12K |
| D7230 |
|
42 |
24 |
$10K |
| D1351 |
Sealant - per tooth |
225 |
32 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
27 |
$8K |
| D1120 |
Prophylaxis - child |
150 |
150 |
$7K |
| D0274 |
Bitewings - four radiographic images |
290 |
290 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
98 |
94 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
16 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
256 |
248 |
$3K |
| D0272 |
Bitewings - two radiographic images |
137 |
137 |
$2K |
| D1330 |
|
271 |
271 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
225 |
219 |
$2K |