| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
930 |
326 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,767 |
1,549 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
571 |
301 |
$28K |
| D1110 |
Prophylaxis - adult |
675 |
643 |
$20K |
| D0330 |
Panoramic radiographic image |
813 |
760 |
$17K |
| D1206 |
Topical application of fluoride varnish |
747 |
699 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,311 |
1,171 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
111 |
77 |
$8K |
| D0274 |
Bitewings - four radiographic images |
780 |
729 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
99 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
249 |
217 |
$5K |
| D1999 |
|
323 |
241 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,620 |
762 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
122 |
117 |
$2K |
| D1120 |
Prophylaxis - child |
91 |
80 |
$2K |
| D2331 |
|
30 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$282.04 |
| D0272 |
Bitewings - two radiographic images |
14 |
12 |
$101.64 |