| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,901 |
2,107 |
$221K |
| D1110 |
Prophylaxis - adult |
3,575 |
3,473 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,709 |
1,734 |
$147K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,141 |
4,983 |
$125K |
| D0330 |
Panoramic radiographic image |
3,410 |
3,290 |
$119K |
| D1120 |
Prophylaxis - child |
2,202 |
2,125 |
$99K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,553 |
1,062 |
$94K |
| D0274 |
Bitewings - four radiographic images |
3,857 |
3,726 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
1,760 |
1,705 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
610 |
417 |
$37K |
| D1206 |
Topical application of fluoride varnish |
2,567 |
2,496 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
992 |
964 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
587 |
454 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
3,407 |
3,179 |
$16K |
| D2335 |
|
183 |
109 |
$14K |
| D2394 |
|
173 |
128 |
$12K |
| D0272 |
Bitewings - two radiographic images |
695 |
679 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,691 |
1,634 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
491 |
470 |
$7K |
| D2332 |
|
44 |
31 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
50 |
$3K |
| D4341 |
|
38 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
12 |
$507.00 |
| D9987 |
|
12 |
12 |
$0.00 |