| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
898 |
398 |
$110K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
491 |
275 |
$51K |
| D1110 |
Prophylaxis - adult |
685 |
675 |
$44K |
| D0330 |
Panoramic radiographic image |
801 |
784 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,078 |
1,070 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,279 |
1,258 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
676 |
638 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
227 |
164 |
$31K |
| D1120 |
Prophylaxis - child |
572 |
565 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
465 |
454 |
$25K |
| D0274 |
Bitewings - four radiographic images |
624 |
613 |
$15K |
| D0272 |
Bitewings - two radiographic images |
378 |
370 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
412 |
400 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
172 |
169 |
$3K |
| D3120 |
|
17 |
12 |
$595.00 |
| D0240 |
|
28 |
28 |
$504.00 |