| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
15,437 |
7,606 |
$870K |
| D1110 |
Prophylaxis - adult |
8,526 |
8,510 |
$735K |
| D0120 |
Periodic oral evaluation - established patient |
6,874 |
6,860 |
$381K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,108 |
5,097 |
$326K |
| D0230 |
Intraoral - periapical each additional radiographic image |
52,329 |
12,573 |
$234K |
| D0274 |
Bitewings - four radiographic images |
6,657 |
6,643 |
$142K |
| D0220 |
Intraoral - periapical first radiographic image |
10,250 |
9,873 |
$122K |
| D9430 |
|
3,161 |
3,134 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,559 |
5,548 |
$77K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
336 |
250 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
530 |
382 |
$36K |
| D1120 |
Prophylaxis - child |
923 |
921 |
$31K |
| D4341 |
|
359 |
133 |
$25K |
| D5110 |
|
31 |
31 |
$20K |
| D5120 |
|
27 |
27 |
$17K |
| D9110 |
|
75 |
72 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
15 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$873.60 |
| D0270 |
|
68 |
68 |
$340.00 |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$336.00 |