| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
700 |
200 |
$46K |
| D1110 |
Prophylaxis - adult |
715 |
702 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
431 |
428 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,066 |
1,059 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
259 |
191 |
$19K |
| D2740 |
Crown - porcelain/ceramic |
36 |
26 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
755 |
747 |
$18K |
| D1120 |
Prophylaxis - child |
429 |
428 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
402 |
399 |
$11K |
| D4342 |
|
250 |
89 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
251 |
241 |
$8K |
| D0274 |
Bitewings - four radiographic images |
295 |
291 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
79 |
61 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
569 |
555 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
92 |
69 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
438 |
418 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
14 |
$2K |
| D2335 |
|
21 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
95 |
94 |
$2K |
| D0330 |
Panoramic radiographic image |
17 |
17 |
$739.18 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$206.18 |