| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,058 |
359 |
$69K |
| D1110 |
Prophylaxis - adult |
2,088 |
2,075 |
$62K |
| D0330 |
Panoramic radiographic image |
1,506 |
1,443 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
804 |
296 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
2,432 |
2,308 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,302 |
1,290 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
1,264 |
944 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,185 |
1,155 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
345 |
344 |
$5K |
| D0274 |
Bitewings - four radiographic images |
283 |
283 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
106 |
86 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
42 |
41 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
171 |
99 |
$276.07 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
34 |
$0.00 |
| D0270 |
|
18 |
18 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
19 |
13 |
$0.00 |
| D2950 |
|
22 |
21 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
95 |
95 |
$0.00 |
| D9994 |
|
126 |
125 |
$0.00 |
| D9630 |
|
86 |
86 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
16 |
$0.00 |