| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,699 |
839 |
$136K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
975 |
262 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,053 |
434 |
$76K |
| D1354 |
|
9,945 |
3,625 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
832 |
767 |
$45K |
| D2941 |
|
3,929 |
1,069 |
$44K |
| D1120 |
Prophylaxis - child |
4,916 |
4,338 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,399 |
2,051 |
$41K |
| D1206 |
Topical application of fluoride varnish |
5,645 |
4,909 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,785 |
1,297 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
3,828 |
3,208 |
$25K |
| D1351 |
Sealant - per tooth |
4,382 |
1,501 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
750 |
349 |
$23K |
| D0272 |
Bitewings - two radiographic images |
2,189 |
1,933 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
5,080 |
4,446 |
$17K |
| D0170 |
|
249 |
227 |
$14K |
| D1330 |
|
7,251 |
6,360 |
$7K |
| D2940 |
|
1,326 |
351 |
$7K |
| D0240 |
|
89 |
45 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
311 |
210 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
387 |
318 |
$972.04 |
| D0274 |
Bitewings - four radiographic images |
273 |
222 |
$642.83 |
| D9920 |
|
21 |
13 |
$440.00 |
| D0603 |
|
7,641 |
6,432 |
$0.85 |
| D1110 |
Prophylaxis - adult |
71 |
46 |
$0.00 |
| D0191 |
|
1,032 |
816 |
$0.00 |
| D0602 |
|
456 |
341 |
$0.00 |
| D1310 |
|
840 |
777 |
$0.00 |
| D0601 |
|
157 |
141 |
$0.00 |