| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,269 |
694 |
$63K |
| D1110 |
Prophylaxis - adult |
1,910 |
1,850 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
533 |
386 |
$34K |
| D1206 |
Topical application of fluoride varnish |
2,476 |
2,386 |
$33K |
| D1120 |
Prophylaxis - child |
1,446 |
1,388 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,551 |
1,490 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
938 |
899 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
467 |
449 |
$18K |
| D0330 |
Panoramic radiographic image |
507 |
497 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
537 |
525 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,084 |
1,046 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
208 |
167 |
$10K |
| D0274 |
Bitewings - four radiographic images |
430 |
430 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
168 |
149 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
35 |
29 |
$962.00 |
| D1351 |
Sealant - per tooth |
36 |
12 |
$767.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
58 |
44 |
$552.00 |
| D0270 |
|
14 |
14 |
$150.00 |