| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,836 |
1,220 |
$230K |
| D1110 |
Prophylaxis - adult |
3,860 |
3,047 |
$159K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,479 |
897 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,761 |
2,798 |
$145K |
| D0210 |
Intraoral - complete series of radiographic images |
3,284 |
2,629 |
$120K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,325 |
637 |
$106K |
| D0274 |
Bitewings - four radiographic images |
4,389 |
3,338 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,610 |
2,283 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,822 |
1,529 |
$59K |
| D1120 |
Prophylaxis - child |
1,440 |
1,440 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
5,257 |
4,135 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,601 |
1,601 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
260 |
169 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,534 |
3,042 |
$19K |
| D0272 |
Bitewings - two radiographic images |
934 |
926 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
273 |
125 |
$18K |
| D4341 |
|
183 |
70 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
254 |
254 |
$10K |
| D1351 |
Sealant - per tooth |
156 |
41 |
$4K |