| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,461 |
1,004 |
$355K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,377 |
2,222 |
$283K |
| D1110 |
Prophylaxis - adult |
4,953 |
4,426 |
$215K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,782 |
953 |
$141K |
| D0330 |
Panoramic radiographic image |
3,390 |
2,999 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
6,485 |
5,867 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,384 |
3,008 |
$114K |
| D0274 |
Bitewings - four radiographic images |
3,542 |
3,180 |
$101K |
| D1120 |
Prophylaxis - child |
3,147 |
2,897 |
$89K |
| D1206 |
Topical application of fluoride varnish |
4,534 |
4,096 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
3,358 |
2,750 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
2,422 |
2,078 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,593 |
966 |
$75K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
316 |
118 |
$51K |
| D2394 |
|
272 |
172 |
$29K |
| D2332 |
|
245 |
138 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,010 |
1,694 |
$21K |
| D2335 |
|
124 |
54 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
353 |
294 |
$9K |
| D1351 |
Sealant - per tooth |
82 |
15 |
$2K |
| D2331 |
|
18 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
163 |
71 |
$1K |
| D2330 |
|
16 |
14 |
$1K |