| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
7,206 |
6,667 |
$1.21M |
| D7140 |
Extraction, erupted tooth or exposed root |
6,291 |
3,271 |
$825K |
| D0120 |
Periodic oral evaluation - established patient |
2,428 |
2,376 |
$555K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,707 |
1,673 |
$316K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,323 |
1,056 |
$245K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,173 |
829 |
$188K |
| D5899 |
|
226 |
165 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
200 |
167 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
180 |
134 |
$33K |
| D2335 |
|
27 |
25 |
$2K |
| D0330 |
Panoramic radiographic image |
3,315 |
3,245 |
$1K |
| D1110 |
Prophylaxis - adult |
2,034 |
1,990 |
$818.02 |
| D1206 |
Topical application of fluoride varnish |
1,838 |
1,805 |
$593.67 |
| D0274 |
Bitewings - four radiographic images |
3,058 |
2,992 |
$387.46 |
| D1120 |
Prophylaxis - child |
1,009 |
996 |
$196.40 |
| D0220 |
Intraoral - periapical first radiographic image |
5,319 |
5,116 |
$186.64 |
| D0272 |
Bitewings - two radiographic images |
458 |
455 |
$120.27 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,530 |
1,206 |
$47.72 |
| D1351 |
Sealant - per tooth |
137 |
44 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
41 |
41 |
$0.00 |