| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
7,339 |
1,984 |
$339K |
| D1110 |
Prophylaxis - adult |
3,933 |
3,870 |
$148K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,528 |
944 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
5,311 |
5,261 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,377 |
4,355 |
$80K |
| D1120 |
Prophylaxis - child |
2,432 |
2,420 |
$72K |
| D0330 |
Panoramic radiographic image |
1,484 |
1,280 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
2,724 |
2,176 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,878 |
1,852 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
404 |
260 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,184 |
1,046 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,642 |
1,371 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
178 |
136 |
$12K |
| D0272 |
Bitewings - two radiographic images |
624 |
618 |
$11K |
| D2332 |
|
64 |
41 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$2K |
| D1351 |
Sealant - per tooth |
50 |
16 |
$2K |
| D1999 |
|
327 |
284 |
$0.00 |