| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,972 |
1,679 |
$217K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
960 |
658 |
$137K |
| D1120 |
Prophylaxis - child |
1,625 |
1,594 |
$85K |
| D0140 |
Limited oral evaluation - problem focused |
1,919 |
1,857 |
$69K |
| D1206 |
Topical application of fluoride varnish |
1,585 |
1,554 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,319 |
1,293 |
$39K |
| D9110 |
|
1,085 |
1,057 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
617 |
608 |
$27K |
| D1351 |
Sealant - per tooth |
601 |
154 |
$24K |
| D1110 |
Prophylaxis - adult |
192 |
189 |
$13K |
| D0272 |
Bitewings - two radiographic images |
424 |
414 |
$13K |
| D7230 |
|
42 |
39 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
255 |
252 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
226 |
222 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
28 |
$4K |
| D0274 |
Bitewings - four radiographic images |
87 |
84 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
154 |
148 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$1K |
| D1354 |
|
87 |
19 |
$1K |
| D0170 |
|
363 |
354 |
$0.00 |
| D9995 |
|
175 |
129 |
$0.00 |
| D0603 |
|
20 |
19 |
$0.00 |