| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,820 |
1,789 |
$203K |
| D0210 |
Intraoral - complete series of radiographic images |
2,721 |
2,547 |
$148K |
| D1110 |
Prophylaxis - adult |
4,095 |
3,900 |
$127K |
| D2335 |
|
1,289 |
604 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,151 |
1,035 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,971 |
3,751 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,901 |
1,047 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
4,138 |
3,944 |
$65K |
| D1351 |
Sealant - per tooth |
2,890 |
700 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,674 |
2,550 |
$49K |
| D1120 |
Prophylaxis - child |
2,327 |
2,239 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,049 |
2,930 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
597 |
433 |
$36K |
| D0330 |
Panoramic radiographic image |
670 |
619 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
323 |
175 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
3,492 |
3,300 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,227 |
2,831 |
$15K |
| D7230 |
|
97 |
61 |
$14K |
| D5214 |
|
29 |
28 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,051 |
1,016 |
$10K |
| D7220 |
|
85 |
68 |
$8K |
| D2332 |
|
122 |
72 |
$7K |
| D2394 |
|
103 |
81 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
285 |
262 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
56 |
31 |
$3K |
| D2140 |
|
39 |
24 |
$2K |