| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,073 |
508 |
$140K |
| D1110 |
Prophylaxis - adult |
2,584 |
2,582 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
3,131 |
3,127 |
$63K |
| D0272 |
Bitewings - two radiographic images |
1,593 |
1,591 |
$26K |
| D0330 |
Panoramic radiographic image |
609 |
609 |
$24K |
| D1330 |
|
2,139 |
2,138 |
$24K |
| D1310 |
|
2,140 |
2,139 |
$23K |
| D2140 |
|
451 |
295 |
$23K |
| D1120 |
Prophylaxis - child |
630 |
630 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
294 |
214 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
804 |
804 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
214 |
213 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
409 |
409 |
$9K |
| D1351 |
Sealant - per tooth |
300 |
40 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
814 |
794 |
$6K |
| D1206 |
Topical application of fluoride varnish |
182 |
182 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
241 |
239 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
29 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
26 |
$2K |
| D2330 |
|
19 |
12 |
$1K |