| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,503 |
1,339 |
$176K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,149 |
4,995 |
$131K |
| D1110 |
Prophylaxis - adult |
2,648 |
2,557 |
$104K |
| D0330 |
Panoramic radiographic image |
2,591 |
2,506 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,426 |
1,044 |
$73K |
| D1120 |
Prophylaxis - child |
1,812 |
1,761 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,640 |
2,551 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
832 |
821 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,256 |
893 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
5,286 |
4,987 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,942 |
1,880 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,212 |
1,177 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,262 |
4,032 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,411 |
1,361 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
676 |
627 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
192 |
160 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
91 |
51 |
$10K |
| D1351 |
Sealant - per tooth |
540 |
132 |
$9K |
| D1206 |
Topical application of fluoride varnish |
595 |
586 |
$8K |
| D2335 |
|
110 |
69 |
$8K |
| D2332 |
|
108 |
79 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
112 |
108 |
$3K |
| D0191 |
|
66 |
66 |
$916.30 |
| D0350 |
|
164 |
108 |
$0.00 |
| D0601 |
|
425 |
410 |
$0.00 |
| D0602 |
|
481 |
470 |
$0.00 |
| D0603 |
|
1,946 |
1,876 |
$0.00 |
| D9995 |
|
81 |
69 |
$0.00 |