| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,046 |
2,188 |
$372K |
| D1110 |
Prophylaxis - adult |
3,567 |
3,558 |
$292K |
| D0140 |
Limited oral evaluation - problem focused |
2,625 |
2,585 |
$197K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,633 |
2,632 |
$187K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,186 |
987 |
$162K |
| D1120 |
Prophylaxis - child |
2,381 |
2,379 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
750 |
607 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,593 |
2,592 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
1,091 |
1,090 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,425 |
2,424 |
$51K |
| D1206 |
Topical application of fluoride varnish |
2,343 |
2,336 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
428 |
289 |
$45K |
| D1351 |
Sealant - per tooth |
1,340 |
454 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,953 |
2,817 |
$31K |
| D0330 |
Panoramic radiographic image |
1,005 |
1,004 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
97 |
88 |
$16K |
| D1354 |
|
377 |
290 |
$9K |
| D2330 |
|
80 |
66 |
$7K |
| D2140 |
|
77 |
54 |
$6K |
| D0272 |
Bitewings - two radiographic images |
256 |
255 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
25 |
$4K |
| D0191 |
|
289 |
289 |
$4K |
| D2331 |
|
40 |
26 |
$4K |
| D2160 |
|
27 |
24 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
123 |
53 |
$699.37 |
| D0180 |
|
12 |
12 |
$663.44 |
| D1330 |
|
894 |
890 |
$0.00 |
| D0603 |
|
287 |
287 |
$0.00 |
| D1310 |
|
13 |
13 |
$0.00 |