| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,339 |
593 |
$209K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,053 |
720 |
$75K |
| D1110 |
Prophylaxis - adult |
1,694 |
1,625 |
$67K |
| D1206 |
Topical application of fluoride varnish |
2,582 |
2,511 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,131 |
2,075 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
783 |
542 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
436 |
146 |
$44K |
| D2740 |
Crown - porcelain/ceramic |
84 |
63 |
$44K |
| D1120 |
Prophylaxis - child |
1,270 |
1,262 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,227 |
1,192 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
590 |
559 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
336 |
264 |
$28K |
| D0330 |
Panoramic radiographic image |
666 |
658 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,040 |
1,016 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,109 |
2,005 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
547 |
531 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
384 |
368 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,477 |
1,402 |
$10K |
| D4342 |
|
272 |
121 |
$9K |
| D2331 |
|
118 |
84 |
$9K |
| D5110 |
|
12 |
12 |
$8K |
| D5120 |
|
12 |
12 |
$8K |
| D0272 |
Bitewings - two radiographic images |
434 |
430 |
$7K |
| D2330 |
|
82 |
54 |
$5K |
| D1351 |
Sealant - per tooth |
102 |
30 |
$3K |
| D4910 |
|
17 |
14 |
$770.20 |