| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,682 |
1,085 |
$152K |
| D1110 |
Prophylaxis - adult |
2,744 |
2,679 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
3,471 |
3,417 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,141 |
893 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
958 |
689 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,723 |
1,655 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,724 |
2,684 |
$44K |
| D0274 |
Bitewings - four radiographic images |
2,002 |
1,933 |
$43K |
| D1120 |
Prophylaxis - child |
2,001 |
1,970 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,703 |
1,654 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,976 |
2,854 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,161 |
1,141 |
$13K |
| D1351 |
Sealant - per tooth |
463 |
142 |
$11K |
| D0330 |
Panoramic radiographic image |
142 |
138 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
54 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
505 |
412 |
$3K |
| D2331 |
|
20 |
15 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
14 |
$1K |