| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,422 |
960 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
2,127 |
1,908 |
$58K |
| D1120 |
Prophylaxis - child |
1,386 |
1,276 |
$55K |
| D1110 |
Prophylaxis - adult |
1,185 |
1,101 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,349 |
1,239 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
497 |
380 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,668 |
1,496 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,142 |
1,044 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
876 |
824 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
3,007 |
2,674 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,538 |
2,218 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
864 |
784 |
$13K |
| D1351 |
Sealant - per tooth |
177 |
92 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
208 |
169 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
109 |
92 |
$7K |
| D0272 |
Bitewings - two radiographic images |
355 |
316 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
38 |
$2K |
| D0270 |
|
182 |
172 |
$996.80 |
| D2332 |
|
13 |
12 |
$988.80 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
14 |
$722.25 |
| D1999 |
|
836 |
613 |
$0.00 |