| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,683 |
516 |
$133K |
| D1110 |
Prophylaxis - adult |
2,754 |
2,623 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,715 |
1,153 |
$113K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
999 |
681 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
3,671 |
3,524 |
$80K |
| D2394 |
|
456 |
317 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
1,022 |
904 |
$54K |
| D1206 |
Topical application of fluoride varnish |
2,324 |
2,237 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,259 |
1,197 |
$40K |
| D1120 |
Prophylaxis - child |
1,328 |
1,288 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
817 |
782 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
812 |
783 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,076 |
976 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
165 |
117 |
$8K |
| D0272 |
Bitewings - two radiographic images |
227 |
220 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
102 |
61 |
$851.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$61.90 |