| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
12,190 |
3,182 |
$739K |
| D0330 |
Panoramic radiographic image |
4,392 |
4,215 |
$210K |
| D1110 |
Prophylaxis - adult |
4,681 |
4,514 |
$175K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,250 |
4,074 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
5,921 |
5,659 |
$109K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,149 |
3,033 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
909 |
640 |
$52K |
| D1120 |
Prophylaxis - child |
2,007 |
1,934 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
561 |
476 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,298 |
1,244 |
$30K |
| D1320 |
|
1,627 |
1,597 |
$25K |
| D1351 |
Sealant - per tooth |
832 |
144 |
$16K |
| D1321 |
|
599 |
587 |
$10K |
| D2330 |
|
103 |
68 |
$6K |
| D2331 |
|
72 |
52 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
137 |
128 |
$4K |
| D2335 |
|
34 |
25 |
$3K |
| D2332 |
|
17 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
26 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
101 |
96 |
$741.67 |
| D0272 |
Bitewings - two radiographic images |
15 |
13 |
$294.75 |