| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,521 |
2,481 |
$115K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,382 |
676 |
$96K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,592 |
644 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,130 |
1,435 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,768 |
1,242 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,985 |
1,529 |
$45K |
| D0274 |
Bitewings - four radiographic images |
2,131 |
1,441 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,789 |
1,263 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
3,640 |
2,607 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
469 |
224 |
$26K |
| D0330 |
Panoramic radiographic image |
1,170 |
762 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
100 |
58 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
846 |
491 |
$5K |
| D1120 |
Prophylaxis - child |
68 |
62 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
60 |
53 |
$2K |
| D0272 |
Bitewings - two radiographic images |
105 |
77 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
98 |
77 |
$1K |
| D9995 |
|
17 |
17 |
$12.27 |
| D1999 |
|
87 |
78 |
$0.00 |
| D1310 |
|
1,057 |
723 |
$0.00 |
| D1330 |
|
1,095 |
744 |
$0.00 |
| D1320 |
|
53 |
31 |
$0.00 |