| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
10,573 |
7,298 |
$876K |
| D0140 |
Limited oral evaluation - problem focused |
6,781 |
6,742 |
$254K |
| D1110 |
Prophylaxis - adult |
5,083 |
5,076 |
$246K |
| D0120 |
Periodic oral evaluation - established patient |
7,913 |
7,902 |
$181K |
| D0220 |
Intraoral - periapical first radiographic image |
8,538 |
8,335 |
$108K |
| D0274 |
Bitewings - four radiographic images |
3,754 |
3,748 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
921 |
712 |
$84K |
| D0330 |
Panoramic radiographic image |
1,504 |
1,503 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,054 |
1,970 |
$67K |
| D1120 |
Prophylaxis - child |
1,661 |
1,658 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,382 |
3,379 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
325 |
255 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,470 |
1,390 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
79 |
64 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
81 |
73 |
$6K |
| D2331 |
|
61 |
48 |
$5K |
| D2140 |
|
78 |
61 |
$5K |
| D0272 |
Bitewings - two radiographic images |
173 |
173 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
14 |
$3K |
| D9920 |
|
12 |
12 |
$620.40 |