| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
987 |
458 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
966 |
959 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
762 |
535 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
854 |
830 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,428 |
1,407 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
2,040 |
2,007 |
$5K |
| D0274 |
Bitewings - four radiographic images |
1,047 |
1,040 |
$5K |
| D1120 |
Prophylaxis - child |
698 |
694 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
463 |
350 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
243 |
210 |
$4K |
| D1110 |
Prophylaxis - adult |
383 |
379 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
942 |
935 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
667 |
664 |
$2K |
| D1206 |
Topical application of fluoride varnish |
391 |
386 |
$1K |
| D2331 |
|
147 |
104 |
$1K |
| D0272 |
Bitewings - two radiographic images |
201 |
199 |
$680.00 |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
31 |
$406.00 |
| D2332 |
|
17 |
13 |
$297.00 |
| D2335 |
|
18 |
13 |
$226.00 |
| D0603 |
|
123 |
123 |
$187.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$52.00 |
| D0240 |
|
28 |
15 |
$48.00 |
| D1330 |
|
1,490 |
1,471 |
$40.07 |
| D0601 |
|
13 |
13 |
$11.00 |
| D1310 |
|
694 |
692 |
$0.01 |
| D9986 |
|
1,057 |
1,025 |
$0.00 |
| D4910 |
|
25 |
25 |
$0.00 |