| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,193 |
1,264 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,280 |
2,092 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,047 |
2,046 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
1,830 |
1,829 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,545 |
1,234 |
$23K |
| D1110 |
Prophylaxis - adult |
2,258 |
2,255 |
$20K |
| D7250 |
|
594 |
241 |
$19K |
| D4341 |
|
1,025 |
430 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
2,331 |
2,290 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,461 |
983 |
$16K |
| D1120 |
Prophylaxis - child |
2,462 |
2,462 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
3,675 |
3,672 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
4,718 |
4,675 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,549 |
3,179 |
$11K |
| D0274 |
Bitewings - four radiographic images |
2,108 |
2,105 |
$10K |
| D1206 |
Topical application of fluoride varnish |
3,154 |
3,154 |
$9K |
| D2335 |
|
352 |
266 |
$7K |
| D4910 |
|
902 |
901 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,986 |
1,981 |
$7K |
| D2332 |
|
382 |
280 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
80 |
49 |
$4K |
| D2331 |
|
300 |
236 |
$4K |
| D0270 |
|
1,073 |
1,062 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
373 |
362 |
$2K |
| D0601 |
|
1,362 |
1,358 |
$2K |
| D2394 |
|
83 |
76 |
$2K |
| D0272 |
Bitewings - two radiographic images |
400 |
400 |
$2K |
| D0191 |
|
992 |
992 |
$1K |
| D5110 |
|
12 |
12 |
$1K |
| D0603 |
|
612 |
611 |
$1K |
| D0602 |
|
602 |
600 |
$880.12 |
| D1330 |
|
4,341 |
4,319 |
$510.00 |
| D2330 |
|
13 |
12 |
$174.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$54.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$52.00 |
| D1310 |
|
592 |
592 |
$0.00 |
| D3120 |
|
30 |
27 |
$0.00 |
| D9986 |
|
2,019 |
1,942 |
$0.00 |