| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,593 |
808 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
3,325 |
3,067 |
$100K |
| D1120 |
Prophylaxis - child |
1,414 |
1,328 |
$68K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
754 |
511 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
3,957 |
3,700 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,444 |
3,043 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,125 |
2,012 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
727 |
650 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,339 |
1,286 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
309 |
160 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,089 |
1,975 |
$19K |
| D1110 |
Prophylaxis - adult |
335 |
313 |
$14K |
| D1351 |
Sealant - per tooth |
773 |
119 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
647 |
568 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
357 |
297 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
105 |
54 |
$5K |
| D2140 |
|
20 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$371.16 |