| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,755 |
1,263 |
$165K |
| D0140 |
Limited oral evaluation - problem focused |
1,547 |
1,368 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
697 |
646 |
$21K |
| D1110 |
Prophylaxis - adult |
484 |
437 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
828 |
738 |
$15K |
| D0330 |
Panoramic radiographic image |
376 |
335 |
$11K |
| D4910 |
|
115 |
99 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
49 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12 |
12 |
$981.02 |
| D0274 |
Bitewings - four radiographic images |
57 |
52 |
$774.92 |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
24 |
$693.80 |
| D1120 |
Prophylaxis - child |
81 |
68 |
$634.25 |
| D1206 |
Topical application of fluoride varnish |
105 |
93 |
$616.04 |
| D2331 |
|
17 |
13 |
$603.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$102.87 |
| D0470 |
|
13 |
12 |
$0.00 |