| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,813 |
1,492 |
$244K |
| D0274 |
Bitewings - four radiographic images |
8,070 |
8,052 |
$229K |
| D9243 |
|
2,869 |
1,258 |
$206K |
| D1120 |
Prophylaxis - child |
6,118 |
6,102 |
$191K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,626 |
1,563 |
$185K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,512 |
820 |
$165K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,005 |
8,984 |
$162K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,961 |
3,946 |
$136K |
| D1110 |
Prophylaxis - adult |
2,815 |
2,808 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
5,416 |
5,411 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
3,683 |
3,644 |
$105K |
| D0330 |
Panoramic radiographic image |
2,017 |
2,012 |
$87K |
| D9239 |
|
705 |
687 |
$84K |
| D2160 |
|
725 |
474 |
$62K |
| D7230 |
|
293 |
131 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,408 |
3,363 |
$38K |
| D2140 |
|
588 |
408 |
$31K |
| D7240 |
Removal of impacted tooth - completely bony |
133 |
48 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
825 |
797 |
$22K |
| D2335 |
|
169 |
100 |
$21K |
| D7250 |
|
152 |
63 |
$19K |
| D2331 |
|
212 |
124 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
178 |
120 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
305 |
288 |
$9K |
| D1351 |
Sealant - per tooth |
186 |
55 |
$4K |
| D0272 |
Bitewings - two radiographic images |
187 |
185 |
$4K |
| D2332 |
|
20 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
144 |
128 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$777.11 |
| D9110 |
|
12 |
12 |
$663.73 |