| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,437 |
1,935 |
$390K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,996 |
1,621 |
$285K |
| D1120 |
Prophylaxis - child |
3,275 |
3,270 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,262 |
3,252 |
$114K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,503 |
842 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
4,055 |
4,040 |
$97K |
| D1110 |
Prophylaxis - adult |
2,327 |
2,313 |
$88K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
822 |
541 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
1,616 |
1,603 |
$81K |
| D1351 |
Sealant - per tooth |
2,822 |
385 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
2,491 |
2,438 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
4,953 |
4,854 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,832 |
2,825 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,385 |
2,369 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,082 |
3,158 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
296 |
180 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,008 |
1,005 |
$21K |
| D1206 |
Topical application of fluoride varnish |
807 |
805 |
$20K |
| D5110 |
|
31 |
31 |
$13K |
| D5120 |
|
14 |
14 |
$7K |
| D2331 |
|
80 |
50 |
$6K |
| D2954 |
|
18 |
14 |
$4K |
| D2330 |
|
62 |
42 |
$4K |
| D2332 |
|
20 |
14 |
$2K |
| D2394 |
|
16 |
12 |
$2K |
| D0270 |
|
76 |
74 |
$695.28 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$340.00 |
| D1999 |
|
1,234 |
1,056 |
$0.00 |