| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
13,444 |
5,449 |
$1.34M |
| D0274 |
Bitewings - four radiographic images |
12,105 |
11,219 |
$585K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31,357 |
10,228 |
$541K |
| D1110 |
Prophylaxis - adult |
6,992 |
6,554 |
$487K |
| D0140 |
Limited oral evaluation - problem focused |
7,453 |
6,863 |
$383K |
| D0330 |
Panoramic radiographic image |
4,699 |
4,331 |
$363K |
| D0220 |
Intraoral - periapical first radiographic image |
17,049 |
15,731 |
$358K |
| D4910 |
|
1,904 |
1,798 |
$209K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,074 |
778 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,182 |
2,941 |
$162K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
842 |
597 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
1,795 |
1,687 |
$71K |
| D1120 |
Prophylaxis - child |
1,599 |
1,437 |
$61K |
| D1206 |
Topical application of fluoride varnish |
1,726 |
1,552 |
$36K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
138 |
53 |
$26K |
| D2331 |
|
89 |
67 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
63 |
54 |
$13K |
| D2330 |
|
66 |
38 |
$8K |
| D2332 |
|
37 |
25 |
$6K |
| D4341 |
|
28 |
13 |
$6K |
| D0272 |
Bitewings - two radiographic images |
150 |
132 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
87 |
68 |
$3K |
| D4355 |
|
12 |
12 |
$2K |
| D2140 |
|
20 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
14 |
$496.80 |
| D9997 |
|
25 |
22 |
$303.60 |