| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,575 |
1,901 |
$262K |
| D1110 |
Prophylaxis - adult |
6,519 |
6,418 |
$205K |
| D2394 |
|
2,799 |
1,313 |
$197K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,242 |
1,848 |
$162K |
| D0330 |
Panoramic radiographic image |
3,900 |
3,841 |
$146K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,349 |
1,393 |
$139K |
| D0274 |
Bitewings - four radiographic images |
6,814 |
6,717 |
$125K |
| D2335 |
|
1,468 |
694 |
$121K |
| D2752 |
|
299 |
140 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,745 |
4,676 |
$110K |
| D5214 |
|
212 |
208 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
6,166 |
6,084 |
$97K |
| D5213 |
|
192 |
192 |
$93K |
| D5110 |
|
255 |
244 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,435 |
918 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
2,830 |
2,624 |
$65K |
| D2332 |
|
780 |
450 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
1,121 |
1,080 |
$50K |
| D7230 |
|
324 |
216 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,662 |
2,631 |
$39K |
| D3320 |
|
136 |
118 |
$37K |
| D1351 |
Sealant - per tooth |
1,766 |
444 |
$37K |
| D1120 |
Prophylaxis - child |
1,840 |
1,805 |
$36K |
| D5120 |
|
108 |
103 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
4,518 |
4,346 |
$21K |
| D4342 |
|
372 |
90 |
$20K |
| D3310 |
|
85 |
53 |
$20K |
| D7310 |
|
222 |
114 |
$19K |
| D7220 |
|
186 |
141 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,108 |
1,089 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,760 |
2,401 |
$12K |
| D0272 |
Bitewings - two radiographic images |
778 |
769 |
$7K |
| D2331 |
|
88 |
70 |
$5K |
| D2952 |
|
32 |
19 |
$4K |
| D2330 |
|
64 |
44 |
$3K |
| D1320 |
|
184 |
171 |
$2K |
| D1330 |
|
42 |
42 |
$465.36 |