| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,315 |
1,223 |
$190K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,393 |
918 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
1,341 |
1,147 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,688 |
1,668 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
835 |
569 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
542 |
412 |
$36K |
| D1110 |
Prophylaxis - adult |
954 |
931 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,338 |
1,286 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,398 |
1,374 |
$23K |
| D1120 |
Prophylaxis - child |
950 |
944 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,057 |
1,049 |
$16K |
| D0274 |
Bitewings - four radiographic images |
633 |
622 |
$13K |
| D0330 |
Panoramic radiographic image |
202 |
199 |
$8K |
| D1351 |
Sealant - per tooth |
339 |
100 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,694 |
1,432 |
$7K |
| D2335 |
|
60 |
36 |
$5K |
| D2394 |
|
48 |
36 |
$4K |
| D2331 |
|
53 |
39 |
$4K |
| D0272 |
Bitewings - two radiographic images |
283 |
281 |
$3K |
| D2332 |
|
18 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
13 |
$1K |
| D2330 |
|
13 |
12 |
$534.70 |
| D0230 |
Intraoral - periapical each additional radiographic image |
135 |
28 |
$390.75 |
| D1320 |
|
12 |
12 |
$183.00 |
| D1999 |
|
362 |
304 |
$0.00 |