| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,330 |
1,763 |
$381K |
| D1110 |
Prophylaxis - adult |
4,059 |
3,964 |
$150K |
| D0330 |
Panoramic radiographic image |
3,210 |
3,123 |
$147K |
| D2335 |
|
1,441 |
653 |
$136K |
| D9944 |
|
541 |
456 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,774 |
3,665 |
$103K |
| D2140 |
|
1,953 |
927 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
3,787 |
3,731 |
$68K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
933 |
590 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,796 |
2,750 |
$44K |
| D2160 |
|
658 |
475 |
$43K |
| D1351 |
Sealant - per tooth |
1,858 |
494 |
$42K |
| D0272 |
Bitewings - two radiographic images |
4,187 |
4,112 |
$42K |
| D1120 |
Prophylaxis - child |
1,896 |
1,859 |
$39K |
| D5110 |
|
96 |
89 |
$38K |
| D5213 |
|
65 |
65 |
$37K |
| D2161 |
|
434 |
318 |
$35K |
| D5214 |
|
61 |
60 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
299 |
261 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
537 |
516 |
$13K |
| D2752 |
|
29 |
13 |
$13K |
| D5120 |
|
29 |
27 |
$11K |
| D0274 |
Bitewings - four radiographic images |
603 |
590 |
$11K |
| D1320 |
|
291 |
276 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,102 |
1,054 |
$5K |
| D2332 |
|
69 |
44 |
$5K |
| D7310 |
|
20 |
14 |
$2K |
| D2931 |
|
13 |
12 |
$2K |