| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,755 |
791 |
$142K |
| D0140 |
Limited oral evaluation - problem focused |
1,727 |
1,556 |
$62K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
581 |
328 |
$52K |
| D0330 |
Panoramic radiographic image |
806 |
751 |
$50K |
| D2140 |
|
697 |
339 |
$50K |
| D1110 |
Prophylaxis - adult |
707 |
660 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,559 |
1,393 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
733 |
669 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
640 |
515 |
$26K |
| D0274 |
Bitewings - four radiographic images |
604 |
562 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
890 |
805 |
$21K |
| D1120 |
Prophylaxis - child |
547 |
492 |
$20K |
| D1351 |
Sealant - per tooth |
562 |
147 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
691 |
652 |
$11K |
| D1320 |
|
268 |
251 |
$7K |