| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,271 |
1,642 |
$271K |
| D0140 |
Limited oral evaluation - problem focused |
2,697 |
2,627 |
$213K |
| D1120 |
Prophylaxis - child |
5,061 |
5,048 |
$202K |
| D1110 |
Prophylaxis - adult |
2,471 |
2,454 |
$173K |
| D1206 |
Topical application of fluoride varnish |
5,896 |
5,882 |
$149K |
| D1351 |
Sealant - per tooth |
5,421 |
1,489 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
979 |
755 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,556 |
1,543 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
920 |
634 |
$96K |
| D0191 |
|
5,801 |
5,788 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
1,326 |
1,313 |
$74K |
| D0210 |
Intraoral - complete series of radiographic images |
1,280 |
1,257 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
357 |
252 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,225 |
1,220 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
199 |
173 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,494 |
2,449 |
$26K |
| D4355 |
|
162 |
160 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,511 |
913 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
91 |
72 |
$10K |
| D2140 |
|
103 |
75 |
$9K |
| D2331 |
|
38 |
26 |
$4K |
| D0272 |
Bitewings - two radiographic images |
83 |
82 |
$2K |
| D2330 |
|
17 |
15 |
$2K |
| D0270 |
|
328 |
324 |
$1K |
| D0602 |
|
137 |
137 |
$43.20 |
| D1310 |
|
346 |
343 |
$29.60 |
| D1330 |
|
325 |
321 |
$0.00 |
| D0603 |
|
235 |
233 |
$0.00 |
| D1353 |
|
176 |
52 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31 |
31 |
$0.00 |