| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,972 |
1,428 |
$412K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,749 |
1,497 |
$180K |
| D1110 |
Prophylaxis - adult |
3,844 |
3,574 |
$165K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,300 |
767 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
4,937 |
4,624 |
$99K |
| D0274 |
Bitewings - four radiographic images |
2,357 |
2,190 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
2,067 |
1,903 |
$67K |
| D1206 |
Topical application of fluoride varnish |
3,483 |
3,233 |
$64K |
| D1120 |
Prophylaxis - child |
2,259 |
2,085 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,394 |
1,277 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,615 |
1,399 |
$37K |
| D0330 |
Panoramic radiographic image |
768 |
700 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,336 |
2,093 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,045 |
966 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
413 |
378 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
304 |
205 |
$17K |
| D2394 |
|
123 |
91 |
$14K |
| D2335 |
|
60 |
39 |
$9K |
| D2331 |
|
83 |
59 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
295 |
212 |
$3K |
| D2332 |
|
17 |
13 |
$2K |
| D9248 |
|
17 |
14 |
$993.12 |
| D1999 |
|
323 |
287 |
$400.00 |