| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,345 |
1,346 |
$407K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,266 |
1,473 |
$292K |
| D4346 |
|
3,781 |
3,731 |
$277K |
| D0330 |
Panoramic radiographic image |
2,857 |
2,765 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
4,585 |
4,545 |
$122K |
| D0140 |
Limited oral evaluation - problem focused |
2,663 |
2,564 |
$110K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
773 |
459 |
$108K |
| D0274 |
Bitewings - four radiographic images |
3,129 |
3,052 |
$102K |
| D1206 |
Topical application of fluoride varnish |
4,625 |
4,553 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
952 |
619 |
$84K |
| D9243 |
|
461 |
373 |
$81K |
| D4342 |
|
561 |
238 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,581 |
1,512 |
$62K |
| D9239 |
|
408 |
375 |
$57K |
| D1120 |
Prophylaxis - child |
1,686 |
1,642 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
677 |
638 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,613 |
1,559 |
$29K |
| D1110 |
Prophylaxis - adult |
312 |
306 |
$14K |
| D0272 |
Bitewings - two radiographic images |
494 |
487 |
$12K |
| D9920 |
|
215 |
211 |
$11K |
| D4910 |
|
56 |
56 |
$6K |
| D4341 |
|
35 |
16 |
$5K |
| D2331 |
|
37 |
27 |
$4K |
| D0367 |
|
23 |
13 |
$3K |
| D4355 |
|
43 |
39 |
$3K |
| D0350 |
|
81 |
81 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$2K |
| D1354 |
|
91 |
21 |
$1K |
| D1330 |
|
41 |
40 |
$546.00 |