| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,099 |
2,505 |
$756K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,950 |
2,005 |
$505K |
| D1110 |
Prophylaxis - adult |
7,840 |
7,731 |
$495K |
| D1351 |
Sealant - per tooth |
11,094 |
2,230 |
$375K |
| D1120 |
Prophylaxis - child |
8,470 |
8,360 |
$368K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,624 |
6,533 |
$355K |
| D0120 |
Periodic oral evaluation - established patient |
11,388 |
11,234 |
$342K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,430 |
10,282 |
$238K |
| D0274 |
Bitewings - four radiographic images |
10,031 |
9,870 |
$230K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,120 |
1,130 |
$214K |
| D0220 |
Intraoral - periapical first radiographic image |
17,869 |
17,435 |
$180K |
| D0140 |
Limited oral evaluation - problem focused |
3,634 |
3,516 |
$167K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,634 |
15,343 |
$151K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
642 |
390 |
$101K |
| D2750 |
|
99 |
73 |
$49K |
| D0272 |
Bitewings - two radiographic images |
2,640 |
2,604 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,524 |
1,515 |
$38K |
| D2950 |
|
142 |
103 |
$12K |
| D1330 |
|
1,243 |
1,243 |
$9K |
| D2331 |
|
54 |
31 |
$6K |
| D2332 |
|
44 |
30 |
$6K |
| D2335 |
|
38 |
25 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
12 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$684.00 |
| D0273 |
|
13 |
13 |
$234.00 |