| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,952 |
1,968 |
$315K |
| D0330 |
Panoramic radiographic image |
3,902 |
3,771 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
4,836 |
4,700 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,848 |
2,732 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
3,299 |
2,975 |
$77K |
| D2335 |
|
788 |
366 |
$76K |
| D2140 |
|
1,499 |
538 |
$66K |
| D1110 |
Prophylaxis - adult |
1,701 |
1,628 |
$59K |
| D5110 |
|
69 |
65 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,262 |
2,188 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
60 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
937 |
904 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
254 |
151 |
$13K |
| D1120 |
Prophylaxis - child |
558 |
533 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
101 |
44 |
$10K |
| D1351 |
Sealant - per tooth |
381 |
73 |
$8K |
| D2331 |
|
87 |
41 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,269 |
1,229 |
$7K |
| D2332 |
|
37 |
13 |
$5K |
| D5120 |
|
14 |
13 |
$5K |
| D2160 |
|
16 |
13 |
$907.00 |
| D9995 |
|
21 |
18 |
$24.54 |