| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,123 |
798 |
$199K |
| D1110 |
Prophylaxis - adult |
3,566 |
3,245 |
$142K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,772 |
939 |
$110K |
| D0330 |
Panoramic radiographic image |
2,226 |
2,100 |
$101K |
| D0274 |
Bitewings - four radiographic images |
3,956 |
3,531 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
3,824 |
3,486 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,046 |
1,928 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,456 |
2,227 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
673 |
358 |
$40K |
| D8670 |
Periodic orthodontic treatment visit |
147 |
125 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
364 |
241 |
$25K |
| D7240 |
Removal of impacted tooth - completely bony |
127 |
46 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,841 |
1,068 |
$18K |
| D0340 |
|
292 |
275 |
$17K |
| D1120 |
Prophylaxis - child |
804 |
749 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,374 |
1,907 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
379 |
335 |
$10K |
| D2394 |
|
128 |
90 |
$9K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
16 |
14 |
$8K |
| D0180 |
|
230 |
170 |
$8K |
| D7230 |
|
35 |
13 |
$6K |
| D0350 |
|
283 |
271 |
$4K |
| D8030 |
|
33 |
31 |
$3K |
| D2332 |
|
21 |
12 |
$2K |