| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,317 |
374 |
$86K |
| D1110 |
Prophylaxis - adult |
1,684 |
1,603 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
897 |
428 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,908 |
1,825 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
147 |
64 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
750 |
700 |
$24K |
| D0274 |
Bitewings - four radiographic images |
686 |
651 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
403 |
194 |
$15K |
| D0330 |
Panoramic radiographic image |
251 |
237 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
421 |
395 |
$12K |
| D1206 |
Topical application of fluoride varnish |
635 |
592 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
532 |
498 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
78 |
75 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
313 |
280 |
$5K |
| D1120 |
Prophylaxis - child |
81 |
79 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
154 |
89 |
$981.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$272.91 |