| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,449 |
1,099 |
$262K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,449 |
1,437 |
$72K |
| D1110 |
Prophylaxis - adult |
924 |
911 |
$52K |
| D1206 |
Topical application of fluoride varnish |
393 |
392 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
643 |
641 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
942 |
934 |
$19K |
| D0330 |
Panoramic radiographic image |
318 |
317 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
157 |
123 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
111 |
91 |
$14K |
| D1120 |
Prophylaxis - child |
502 |
501 |
$12K |
| D2752 |
|
13 |
13 |
$11K |
| D9222 |
|
37 |
37 |
$9K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
37 |
37 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
580 |
574 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
68 |
68 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
30 |
$4K |
| D9995 |
|
131 |
129 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
60 |
58 |
$3K |
| D0272 |
Bitewings - two radiographic images |
126 |
126 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$762.26 |
| D0270 |
|
70 |
70 |
$729.11 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$194.04 |