| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,400 |
669 |
$86K |
| D1110 |
Prophylaxis - adult |
1,407 |
1,398 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
625 |
500 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
796 |
795 |
$36K |
| D1120 |
Prophylaxis - child |
1,127 |
1,120 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,586 |
1,574 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
621 |
467 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,570 |
1,559 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,334 |
1,329 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
403 |
384 |
$18K |
| D0274 |
Bitewings - four radiographic images |
599 |
590 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
124 |
106 |
$8K |
| D0272 |
Bitewings - two radiographic images |
455 |
454 |
$7K |
| D2331 |
|
88 |
67 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
70 |
59 |
$4K |
| D1351 |
Sealant - per tooth |
144 |
35 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
61 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
243 |
242 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
15 |
$184.00 |