| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,551 |
2,539 |
$382K |
| D1110 |
Prophylaxis - adult |
6,113 |
5,928 |
$229K |
| D0210 |
Intraoral - complete series of radiographic images |
3,013 |
2,920 |
$186K |
| D2335 |
|
1,758 |
786 |
$163K |
| D0120 |
Periodic oral evaluation - established patient |
6,813 |
6,576 |
$136K |
| D0274 |
Bitewings - four radiographic images |
5,615 |
5,448 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,526 |
4,398 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,615 |
935 |
$90K |
| D0140 |
Limited oral evaluation - problem focused |
3,359 |
3,173 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,526 |
4,379 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,288 |
867 |
$78K |
| D1120 |
Prophylaxis - child |
3,141 |
3,019 |
$72K |
| D2394 |
|
701 |
513 |
$57K |
| D2740 |
Crown - porcelain/ceramic |
54 |
42 |
$44K |
| D1351 |
Sealant - per tooth |
1,623 |
369 |
$35K |
| D7310 |
|
187 |
95 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,285 |
1,220 |
$16K |
| D0250 |
|
1,208 |
1,183 |
$16K |
| D1320 |
|
587 |
552 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
145 |
105 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
198 |
117 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,211 |
1,174 |
$7K |
| D2161 |
|
79 |
64 |
$6K |
| D0330 |
Panoramic radiographic image |
97 |
93 |
$4K |
| D7230 |
|
22 |
14 |
$3K |
| D0180 |
|
82 |
82 |
$2K |
| D2332 |
|
27 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
59 |
56 |
$984.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
125 |
105 |
$681.94 |