| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,324 |
1,457 |
$213K |
| D0330 |
Panoramic radiographic image |
4,616 |
4,333 |
$154K |
| D1120 |
Prophylaxis - child |
3,550 |
3,394 |
$108K |
| D1206 |
Topical application of fluoride varnish |
5,248 |
4,995 |
$100K |
| D1351 |
Sealant - per tooth |
11,013 |
1,599 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,790 |
3,609 |
$88K |
| D1110 |
Prophylaxis - adult |
1,631 |
1,543 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
2,479 |
2,271 |
$55K |
| D0272 |
Bitewings - two radiographic images |
3,587 |
3,386 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
260 |
172 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
582 |
571 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
240 |
162 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
241 |
234 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
328 |
309 |
$3K |
| D1355 |
|
17 |
12 |
$0.00 |