| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
8,242 |
2,381 |
$337K |
| D1110 |
Prophylaxis - adult |
5,394 |
5,021 |
$221K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,217 |
857 |
$146K |
| D0330 |
Panoramic radiographic image |
2,829 |
2,578 |
$119K |
| D0140 |
Limited oral evaluation - problem focused |
3,269 |
2,970 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,999 |
1,841 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,567 |
2,367 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
593 |
397 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,339 |
965 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,813 |
3,396 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
661 |
253 |
$45K |
| D4341 |
|
335 |
154 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
850 |
796 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
156 |
122 |
$24K |
| D0272 |
Bitewings - two radiographic images |
962 |
910 |
$17K |
| D2330 |
|
81 |
55 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
63 |
26 |
$9K |
| D2332 |
|
19 |
12 |
$4K |
| D2140 |
|
23 |
12 |
$3K |
| D4355 |
|
51 |
49 |
$3K |
| D9996 |
|
174 |
158 |
$2K |
| D0270 |
|
246 |
219 |
$2K |
| D1206 |
Topical application of fluoride varnish |
187 |
177 |
$788.90 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
13 |
$366.48 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$278.52 |
| D0350 |
|
683 |
151 |
$0.00 |
| D1120 |
Prophylaxis - child |
22 |
22 |
$0.00 |