| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,739 |
890 |
$127K |
| D0330 |
Panoramic radiographic image |
2,447 |
2,288 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,429 |
1,335 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
933 |
866 |
$19K |
| D1110 |
Prophylaxis - adult |
573 |
533 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
49 |
45 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
216 |
125 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
210 |
139 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
208 |
92 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
601 |
386 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,803 |
1,682 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,957 |
1,348 |
$8K |
| D9243 |
|
370 |
57 |
$6K |
| D9239 |
|
76 |
58 |
$4K |
| D0274 |
Bitewings - four radiographic images |
509 |
465 |
$3K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
76 |
16 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
28 |
$2K |
| D9222 |
|
18 |
17 |
$2K |
| D2330 |
|
26 |
15 |
$1K |
| D2394 |
|
16 |
13 |
$1K |
| D2950 |
|
15 |
14 |
$995.02 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$240.00 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$239.12 |
| D0270 |
|
12 |
12 |
$60.00 |