| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,013 |
1,541 |
$194K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,611 |
961 |
$103K |
| D0210 |
Intraoral - complete series of radiographic images |
1,705 |
1,646 |
$73K |
| D1110 |
Prophylaxis - adult |
2,395 |
2,363 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
943 |
545 |
$52K |
| D5110 |
|
72 |
72 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,332 |
2,268 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,157 |
1,577 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
296 |
264 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
2,342 |
2,306 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
3,396 |
3,285 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,730 |
1,691 |
$30K |
| D4341 |
|
294 |
142 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,143 |
1,127 |
$21K |
| D1206 |
Topical application of fluoride varnish |
995 |
982 |
$15K |
| D1120 |
Prophylaxis - child |
463 |
457 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
128 |
112 |
$11K |
| D2331 |
|
60 |
42 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
31 |
$644.49 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$241.80 |
| D1999 |
|
68 |
56 |
$0.00 |
| D2950 |
|
23 |
15 |
$0.00 |
| D2332 |
|
21 |
14 |
$0.00 |