| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,009 |
913 |
$123K |
| D0140 |
Limited oral evaluation - problem focused |
2,772 |
2,166 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,928 |
2,881 |
$85K |
| D1120 |
Prophylaxis - child |
3,862 |
2,834 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,312 |
437 |
$74K |
| D0330 |
Panoramic radiographic image |
2,089 |
1,549 |
$68K |
| D0272 |
Bitewings - two radiographic images |
2,906 |
2,032 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
308 |
132 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
397 |
87 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,014 |
831 |
$14K |
| D2140 |
|
355 |
85 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
282 |
25 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
53 |
12 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
197 |
50 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
74 |
60 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
54 |
46 |
$600.94 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$348.00 |
| D0190 |
|
498 |
365 |
$0.00 |
| D1999 |
|
492 |
360 |
$0.00 |