| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
16,956 |
7,336 |
$954K |
| D1110 |
Prophylaxis - adult |
15,052 |
14,172 |
$502K |
| D0330 |
Panoramic radiographic image |
10,198 |
9,605 |
$451K |
| D0120 |
Periodic oral evaluation - established patient |
22,348 |
20,856 |
$372K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,582 |
4,118 |
$352K |
| D1206 |
Topical application of fluoride varnish |
22,429 |
20,733 |
$323K |
| D1120 |
Prophylaxis - child |
15,543 |
14,317 |
$298K |
| D0274 |
Bitewings - four radiographic images |
14,375 |
13,527 |
$282K |
| D0140 |
Limited oral evaluation - problem focused |
12,493 |
11,753 |
$274K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,088 |
8,445 |
$233K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
910 |
749 |
$93K |
| D2140 |
|
2,289 |
1,494 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,559 |
1,101 |
$84K |
| D0272 |
Bitewings - two radiographic images |
7,786 |
7,196 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,316 |
881 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
12,407 |
11,641 |
$61K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
755 |
636 |
$48K |
| D2160 |
|
515 |
414 |
$33K |
| D1351 |
Sealant - per tooth |
1,457 |
374 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,902 |
1,990 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
156 |
134 |
$10K |
| D1354 |
|
567 |
208 |
$8K |
| D4341 |
|
56 |
12 |
$4K |
| D2931 |
|
28 |
25 |
$3K |
| D2331 |
|
34 |
24 |
$2K |
| D0180 |
|
62 |
57 |
$2K |
| D1320 |
|
40 |
40 |
$2K |
| D2335 |
|
14 |
12 |
$1K |
| D0240 |
|
13 |
13 |
$156.00 |
| D0601 |
|
13 |
12 |
$0.00 |
| D1330 |
|
19 |
18 |
$0.00 |