| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,995 |
661 |
$244K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,417 |
853 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
3,971 |
3,934 |
$119K |
| D1120 |
Prophylaxis - child |
2,358 |
2,342 |
$104K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,044 |
523 |
$103K |
| D1110 |
Prophylaxis - adult |
1,473 |
1,464 |
$92K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
515 |
333 |
$85K |
| D1206 |
Topical application of fluoride varnish |
1,418 |
1,406 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
705 |
676 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,404 |
1,404 |
$32K |
| D0330 |
Panoramic radiographic image |
682 |
669 |
$30K |
| D0274 |
Bitewings - four radiographic images |
643 |
634 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
278 |
272 |
$14K |
| D1351 |
Sealant - per tooth |
352 |
61 |
$12K |
| D0272 |
Bitewings - two radiographic images |
571 |
563 |
$9K |
| D2332 |
|
43 |
25 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
316 |
303 |
$6K |
| D1330 |
|
930 |
930 |
$6K |
| D2394 |
|
32 |
24 |
$6K |
| D2331 |
|
36 |
24 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
89 |
88 |
$1K |