| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,165 |
425 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,226 |
2,220 |
$42K |
| D1110 |
Prophylaxis - adult |
831 |
823 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
2,005 |
1,999 |
$36K |
| D1120 |
Prophylaxis - child |
1,071 |
1,068 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,266 |
977 |
$23K |
| D0274 |
Bitewings - four radiographic images |
480 |
477 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,428 |
1,119 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
952 |
328 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
272 |
223 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
72 |
46 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
144 |
127 |
$5K |
| D0272 |
Bitewings - two radiographic images |
63 |
63 |
$1K |