| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,475 |
587 |
$94K |
| D1110 |
Prophylaxis - adult |
2,654 |
2,617 |
$91K |
| D1351 |
Sealant - per tooth |
3,464 |
520 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
3,235 |
3,191 |
$62K |
| D5214 |
|
95 |
93 |
$50K |
| D0330 |
Panoramic radiographic image |
1,317 |
1,300 |
$47K |
| D2335 |
|
584 |
310 |
$37K |
| D5213 |
|
58 |
58 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
385 |
306 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
407 |
318 |
$24K |
| D0274 |
Bitewings - four radiographic images |
758 |
753 |
$20K |
| D1120 |
Prophylaxis - child |
627 |
620 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,005 |
990 |
$18K |
| D0272 |
Bitewings - two radiographic images |
877 |
867 |
$14K |
| D2332 |
|
175 |
105 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,312 |
1,279 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
138 |
91 |
$7K |
| D9110 |
|
105 |
102 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
354 |
320 |
$3K |
| D2330 |
|
34 |
27 |
$2K |
| D1330 |
|
125 |
125 |
$1K |
| D1310 |
|
126 |
126 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
53 |
$1K |