| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,434 |
1,332 |
$247K |
| D1110 |
Prophylaxis - adult |
4,236 |
4,215 |
$168K |
| D0120 |
Periodic oral evaluation - established patient |
3,949 |
3,928 |
$96K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,208 |
821 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,296 |
2,287 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
946 |
943 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,760 |
2,698 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
593 |
586 |
$31K |
| D1330 |
|
2,222 |
2,203 |
$22K |
| D1310 |
|
2,224 |
2,204 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
962 |
752 |
$15K |
| D2140 |
|
295 |
218 |
$15K |
| D2331 |
|
197 |
147 |
$14K |
| D0330 |
Panoramic radiographic image |
322 |
320 |
$13K |
| D5110 |
|
25 |
25 |
$13K |
| D2160 |
|
158 |
134 |
$12K |
| D9110 |
|
281 |
278 |
$9K |
| D2330 |
|
133 |
98 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
92 |
74 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
100 |
72 |
$6K |
| D2332 |
|
45 |
38 |
$4K |
| D2335 |
|
16 |
15 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
72 |
72 |
$1K |
| D1206 |
Topical application of fluoride varnish |
66 |
66 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$693.45 |