| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
11,663 |
4,466 |
$701K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
7,115 |
3,719 |
$420K |
| D1110 |
Prophylaxis - adult |
10,141 |
10,004 |
$368K |
| D0330 |
Panoramic radiographic image |
5,799 |
5,718 |
$297K |
| D0140 |
Limited oral evaluation - problem focused |
11,739 |
11,363 |
$290K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38,121 |
14,298 |
$272K |
| D0120 |
Periodic oral evaluation - established patient |
10,792 |
10,663 |
$225K |
| D1206 |
Topical application of fluoride varnish |
11,652 |
11,528 |
$220K |
| D0220 |
Intraoral - periapical first radiographic image |
20,116 |
19,191 |
$203K |
| D1120 |
Prophylaxis - child |
7,213 |
7,166 |
$183K |
| D0274 |
Bitewings - four radiographic images |
7,364 |
7,245 |
$179K |
| D2331 |
|
2,706 |
1,534 |
$174K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,140 |
6,053 |
$172K |
| D1351 |
Sealant - per tooth |
8,260 |
1,961 |
$159K |
| D2140 |
|
3,638 |
2,173 |
$143K |
| D2160 |
|
1,936 |
1,492 |
$131K |
| D1354 |
|
5,312 |
1,251 |
$127K |
| D2161 |
|
1,156 |
957 |
$93K |
| D2332 |
|
1,186 |
803 |
$92K |
| D2335 |
|
1,193 |
802 |
$87K |
| D0272 |
Bitewings - two radiographic images |
3,284 |
3,260 |
$77K |
| D2330 |
|
1,630 |
1,020 |
$74K |
| D3320 |
|
368 |
317 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
975 |
609 |
$34K |
| D1330 |
|
3,299 |
3,265 |
$31K |
| D7111 |
|
319 |
177 |
$27K |
| D5212 |
|
61 |
58 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
180 |
136 |
$18K |
| D5211 |
|
39 |
38 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
389 |
307 |
$14K |
| D4355 |
|
451 |
430 |
$12K |
| D3310 |
|
70 |
40 |
$10K |
| D0273 |
|
134 |
133 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21 |
12 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$0.00 |