| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,126 |
615 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
878 |
515 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,888 |
1,817 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
452 |
167 |
$38K |
| D1120 |
Prophylaxis - child |
1,821 |
1,766 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
893 |
876 |
$32K |
| D1206 |
Topical application of fluoride varnish |
2,321 |
2,237 |
$30K |
| D1110 |
Prophylaxis - adult |
654 |
635 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,167 |
1,138 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
308 |
197 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
251 |
185 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
676 |
645 |
$15K |
| D0274 |
Bitewings - four radiographic images |
542 |
527 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
180 |
165 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
298 |
283 |
$3K |
| D1351 |
Sealant - per tooth |
80 |
26 |
$1K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$368.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$348.00 |