| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,803 |
754 |
$141K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
443 |
272 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,910 |
1,876 |
$45K |
| D1120 |
Prophylaxis - child |
953 |
947 |
$40K |
| D1110 |
Prophylaxis - adult |
893 |
873 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
313 |
149 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,042 |
1,035 |
$24K |
| D1351 |
Sealant - per tooth |
488 |
83 |
$16K |
| D0330 |
Panoramic radiographic image |
369 |
361 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
271 |
251 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104 |
104 |
$5K |
| D0274 |
Bitewings - four radiographic images |
254 |
249 |
$5K |
| D1330 |
|
625 |
622 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
28 |
$4K |
| D0272 |
Bitewings - two radiographic images |
241 |
238 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
211 |
199 |
$1K |