| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,668 |
676 |
$85K |
| D1120 |
Prophylaxis - child |
2,073 |
1,903 |
$80K |
| D1351 |
Sealant - per tooth |
1,651 |
589 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,442 |
2,207 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,022 |
592 |
$60K |
| D1206 |
Topical application of fluoride varnish |
2,052 |
1,886 |
$49K |
| D1110 |
Prophylaxis - adult |
1,008 |
900 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
768 |
438 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,723 |
1,547 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,293 |
1,196 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,644 |
3,302 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,718 |
2,998 |
$16K |
| D5110 |
|
25 |
25 |
$9K |
| D0272 |
Bitewings - two radiographic images |
938 |
873 |
$8K |
| D0330 |
Panoramic radiographic image |
390 |
357 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
94 |
48 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
229 |
197 |
$3K |
| D2330 |
|
57 |
40 |
$3K |
| D2332 |
|
27 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$839.90 |
| D0270 |
|
141 |
124 |
$772.80 |
| D0210 |
Intraoral - complete series of radiographic images |
68 |
60 |
$321.40 |