| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,893 |
848 |
$220K |
| D1110 |
Prophylaxis - adult |
3,944 |
3,547 |
$202K |
| D1351 |
Sealant - per tooth |
6,260 |
735 |
$183K |
| D0330 |
Panoramic radiographic image |
2,457 |
2,201 |
$154K |
| D0120 |
Periodic oral evaluation - established patient |
5,428 |
4,676 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,302 |
887 |
$119K |
| D0274 |
Bitewings - four radiographic images |
3,302 |
2,906 |
$118K |
| D1120 |
Prophylaxis - child |
2,964 |
2,500 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
926 |
680 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,539 |
3,854 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
2,051 |
1,859 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
515 |
489 |
$18K |
| D2330 |
|
60 |
39 |
$4K |
| D2331 |
|
33 |
25 |
$3K |
| D1206 |
Topical application of fluoride varnish |
73 |
72 |
$1K |
| D1999 |
|
1,644 |
1,162 |
$0.00 |