| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,687 |
2,332 |
$471K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,292 |
1,039 |
$161K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,031 |
656 |
$131K |
| D0140 |
Limited oral evaluation - problem focused |
4,343 |
4,225 |
$128K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,033 |
757 |
$105K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
524 |
474 |
$79K |
| D1110 |
Prophylaxis - adult |
1,315 |
1,292 |
$75K |
| D0330 |
Panoramic radiographic image |
1,740 |
1,724 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,233 |
1,217 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,300 |
1,286 |
$49K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
403 |
327 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,678 |
3,549 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
522 |
512 |
$38K |
| D1206 |
Topical application of fluoride varnish |
2,109 |
2,078 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
928 |
906 |
$30K |
| D0270 |
|
1,983 |
1,933 |
$22K |
| D2331 |
|
201 |
169 |
$20K |
| D4910 |
|
257 |
253 |
$19K |
| D1120 |
Prophylaxis - child |
371 |
364 |
$15K |
| D2950 |
|
104 |
97 |
$13K |
| D4341 |
|
75 |
39 |
$9K |
| D2330 |
|
80 |
56 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
192 |
174 |
$6K |
| D2332 |
|
28 |
25 |
$3K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$3K |
| D2940 |
|
43 |
39 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
119 |
61 |
$2K |
| D0272 |
Bitewings - two radiographic images |
44 |
42 |
$1K |