| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,054 |
829 |
$193K |
| D1110 |
Prophylaxis - adult |
3,247 |
3,228 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,553 |
831 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
4,523 |
4,492 |
$87K |
| D2332 |
|
1,199 |
479 |
$76K |
| D1351 |
Sealant - per tooth |
2,380 |
431 |
$58K |
| D0330 |
Panoramic radiographic image |
1,364 |
1,353 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
657 |
405 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,587 |
1,577 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
561 |
377 |
$27K |
| D1120 |
Prophylaxis - child |
832 |
826 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,561 |
1,554 |
$24K |
| D5110 |
|
13 |
13 |
$6K |
| D9110 |
|
89 |
87 |
$3K |