| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,504 |
1,695 |
$425K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,513 |
2,350 |
$391K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,169 |
1,669 |
$170K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,212 |
765 |
$114K |
| D9248 |
|
2,187 |
1,990 |
$111K |
| D1110 |
Prophylaxis - adult |
2,419 |
2,284 |
$105K |
| D0140 |
Limited oral evaluation - problem focused |
3,098 |
2,864 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
4,026 |
3,816 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
1,580 |
1,432 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,222 |
2,091 |
$81K |
| D1120 |
Prophylaxis - child |
2,065 |
1,961 |
$67K |
| D1206 |
Topical application of fluoride varnish |
3,380 |
3,198 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,375 |
1,301 |
$43K |
| D2335 |
|
322 |
174 |
$41K |
| D0330 |
Panoramic radiographic image |
898 |
836 |
$39K |
| D2332 |
|
341 |
205 |
$34K |
| D7111 |
|
441 |
228 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,183 |
1,121 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,340 |
2,078 |
$26K |
| D2331 |
|
158 |
113 |
$14K |
| D1351 |
Sealant - per tooth |
428 |
103 |
$11K |
| D2931 |
|
59 |
50 |
$11K |
| D2330 |
|
132 |
79 |
$10K |
| D2949 |
|
48 |
39 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
245 |
224 |
$6K |
| D1999 |
|
502 |
406 |
$592.70 |
| D0230 |
Intraoral - periapical each additional radiographic image |
41 |
37 |
$570.18 |
| D9920 |
|
30 |
27 |
$514.25 |
| D1208 |
Topical application of fluoride, excluding varnish |
82 |
75 |
$44.78 |