| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,568 |
2,026 |
$672K |
| D1110 |
Prophylaxis - adult |
9,175 |
9,129 |
$565K |
| D0330 |
Panoramic radiographic image |
5,454 |
5,423 |
$440K |
| D0120 |
Periodic oral evaluation - established patient |
9,388 |
9,351 |
$350K |
| D1206 |
Topical application of fluoride varnish |
10,727 |
10,694 |
$339K |
| D0274 |
Bitewings - four radiographic images |
7,535 |
7,501 |
$332K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,990 |
4,971 |
$225K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,125 |
1,271 |
$204K |
| D1120 |
Prophylaxis - child |
4,579 |
4,569 |
$196K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,952 |
1,218 |
$182K |
| D0140 |
Limited oral evaluation - problem focused |
3,580 |
3,510 |
$146K |
| D1351 |
Sealant - per tooth |
3,802 |
1,035 |
$141K |
| D5110 |
|
101 |
96 |
$106K |
| D2160 |
|
795 |
591 |
$90K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
530 |
362 |
$74K |
| D0272 |
Bitewings - two radiographic images |
2,008 |
2,005 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
802 |
549 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
3,820 |
3,743 |
$62K |
| D2140 |
|
795 |
577 |
$59K |
| D2335 |
|
376 |
264 |
$51K |
| D1330 |
|
1,374 |
1,359 |
$28K |
| D2330 |
|
285 |
207 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
168 |
122 |
$21K |
| D2161 |
|
125 |
104 |
$17K |
| D5120 |
|
12 |
12 |
$15K |
| D2332 |
|
72 |
54 |
$10K |
| D4341 |
|
40 |
15 |
$9K |
| D4910 |
|
101 |
99 |
$8K |
| D2331 |
|
77 |
55 |
$8K |
| D4355 |
|
139 |
137 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
558 |
376 |
$6K |
| D2394 |
|
21 |
12 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31 |
29 |
$639.15 |