| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,043 |
489 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
2,132 |
1,667 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
699 |
332 |
$60K |
| D1120 |
Prophylaxis - child |
2,032 |
1,892 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,318 |
1,250 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,958 |
1,824 |
$29K |
| D0330 |
Panoramic radiographic image |
558 |
541 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
704 |
616 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
197 |
122 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,182 |
1,030 |
$13K |
| D0274 |
Bitewings - four radiographic images |
275 |
263 |
$8K |
| D0272 |
Bitewings - two radiographic images |
203 |
200 |
$4K |
| D0350 |
|
123 |
107 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
111 |
56 |
$857.51 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
157 |
121 |
$220.96 |
| D1999 |
|
508 |
404 |
$0.00 |