| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
7,337 |
1,228 |
$512K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,400 |
874 |
$147K |
| D5130 |
|
97 |
97 |
$86K |
| D0330 |
Panoramic radiographic image |
1,614 |
1,614 |
$80K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
339 |
257 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,289 |
1,276 |
$41K |
| D1110 |
Prophylaxis - adult |
732 |
732 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,020 |
1,020 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
492 |
353 |
$30K |
| D5140 |
|
31 |
31 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,502 |
1,502 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,640 |
1,616 |
$26K |
| D0274 |
Bitewings - four radiographic images |
610 |
610 |
$19K |
| D1120 |
Prophylaxis - child |
599 |
599 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,829 |
1,010 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
404 |
367 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
421 |
421 |
$9K |
| D0272 |
Bitewings - two radiographic images |
214 |
214 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
12 |
$3K |
| D1320 |
|
48 |
46 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
101 |
101 |
$1K |
| D0240 |
|
71 |
71 |
$1K |