| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,128 |
528 |
$282K |
| D1110 |
Prophylaxis - adult |
1,649 |
1,635 |
$105K |
| D0330 |
Panoramic radiographic image |
1,747 |
1,737 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
575 |
400 |
$77K |
| D1206 |
Topical application of fluoride varnish |
2,735 |
2,708 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,410 |
1,347 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,162 |
1,155 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
403 |
273 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,340 |
1,325 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,067 |
1,064 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,047 |
1,931 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
119 |
94 |
$20K |
| D1120 |
Prophylaxis - child |
398 |
391 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,121 |
1,089 |
$11K |
| D2335 |
|
16 |
12 |
$3K |
| D1330 |
|
394 |
387 |
$2K |
| D2330 |
|
23 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
77 |
72 |
$2K |