| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,532 |
1,332 |
$129K |
| D0330 |
Panoramic radiographic image |
2,414 |
2,386 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,559 |
3,497 |
$84K |
| D1120 |
Prophylaxis - child |
1,617 |
1,581 |
$69K |
| D1110 |
Prophylaxis - adult |
1,603 |
1,576 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,903 |
1,871 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,831 |
1,803 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
798 |
476 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,470 |
2,415 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
302 |
169 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
562 |
354 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
285 |
175 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
705 |
684 |
$5K |
| D0272 |
Bitewings - two radiographic images |
229 |
223 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
51 |
40 |
$2K |
| D4341 |
|
29 |
12 |
$2K |
| D2335 |
|
22 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
64 |
41 |
$375.46 |
| D1999 |
|
1,111 |
987 |
$0.00 |
| D9987 |
|
467 |
373 |
$0.00 |
| D9986 |
|
305 |
258 |
$0.00 |