| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,286 |
1,187 |
$241K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,945 |
2,210 |
$239K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,380 |
4,853 |
$178K |
| D0210 |
Intraoral - complete series of radiographic images |
3,960 |
3,463 |
$171K |
| D1110 |
Prophylaxis - adult |
4,099 |
3,723 |
$168K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,973 |
1,669 |
$147K |
| D0330 |
Panoramic radiographic image |
3,515 |
3,164 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
5,913 |
5,345 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
3,220 |
2,864 |
$101K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,399 |
893 |
$101K |
| D0274 |
Bitewings - four radiographic images |
3,000 |
2,699 |
$83K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
870 |
284 |
$81K |
| D1120 |
Prophylaxis - child |
3,418 |
3,116 |
$64K |
| D1351 |
Sealant - per tooth |
2,983 |
421 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,955 |
2,590 |
$44K |
| D1206 |
Topical application of fluoride varnish |
1,827 |
1,663 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,451 |
2,139 |
$25K |
| D2335 |
|
279 |
122 |
$20K |
| D2332 |
|
196 |
122 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
827 |
657 |
$15K |
| D0272 |
Bitewings - two radiographic images |
582 |
534 |
$8K |
| D4341 |
|
47 |
12 |
$4K |
| D2394 |
|
14 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
112 |
68 |
$836.80 |
| D1999 |
|
236 |
187 |
$675.00 |
| D2140 |
|
42 |
25 |
$433.30 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
13 |
$162.28 |
| D0431 |
|
15 |
13 |
$0.00 |