| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,873 |
1,795 |
$335K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,843 |
6,501 |
$202K |
| D0330 |
Panoramic radiographic image |
2,542 |
2,386 |
$139K |
| D1110 |
Prophylaxis - adult |
3,024 |
2,853 |
$124K |
| D0140 |
Limited oral evaluation - problem focused |
4,263 |
3,804 |
$107K |
| D0274 |
Bitewings - four radiographic images |
3,351 |
3,199 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
946 |
722 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,818 |
3,634 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
915 |
657 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
735 |
660 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
5,453 |
5,144 |
$31K |
| D1120 |
Prophylaxis - child |
1,662 |
1,597 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,110 |
2,033 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,021 |
963 |
$21K |
| D1351 |
Sealant - per tooth |
956 |
263 |
$20K |
| D2330 |
|
211 |
133 |
$14K |
| D1320 |
|
749 |
708 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
128 |
109 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,016 |
981 |
$10K |
| D2331 |
|
91 |
68 |
$10K |
| D2332 |
|
25 |
19 |
$4K |
| D2335 |
|
36 |
24 |
$3K |
| D2394 |
|
45 |
40 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
31 |
$3K |
| D2140 |
|
46 |
29 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
14 |
$756.00 |
| D0270 |
|
38 |
37 |
$190.00 |
| D1999 |
|
65 |
58 |
$0.00 |