| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,325 |
1,221 |
$351K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,236 |
1,239 |
$223K |
| D0140 |
Limited oral evaluation - problem focused |
3,724 |
3,652 |
$162K |
| D0120 |
Periodic oral evaluation - established patient |
3,920 |
3,917 |
$160K |
| D1110 |
Prophylaxis - adult |
2,366 |
2,363 |
$152K |
| D0330 |
Panoramic radiographic image |
1,529 |
1,526 |
$143K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,457 |
4,231 |
$131K |
| D1120 |
Prophylaxis - child |
2,907 |
2,906 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
5,789 |
5,669 |
$107K |
| D1206 |
Topical application of fluoride varnish |
3,097 |
3,094 |
$104K |
| D2331 |
|
728 |
417 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,321 |
1,321 |
$73K |
| D2161 |
|
478 |
379 |
$69K |
| D2160 |
|
549 |
437 |
$66K |
| D2140 |
|
839 |
550 |
$66K |
| D2332 |
|
459 |
297 |
$65K |
| D0272 |
Bitewings - two radiographic images |
1,562 |
1,560 |
$62K |
| D1354 |
|
1,436 |
381 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,039 |
1,039 |
$49K |
| D1351 |
Sealant - per tooth |
1,034 |
254 |
$42K |
| D2335 |
|
242 |
154 |
$35K |
| D2330 |
|
247 |
168 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
116 |
99 |
$17K |
| D0273 |
|
357 |
357 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
164 |
124 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
194 |
130 |
$15K |
| D7111 |
|
59 |
38 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
33 |
13 |
$6K |