| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
7,734 |
2,905 |
$575K |
| D1110 |
Prophylaxis - adult |
8,999 |
8,960 |
$390K |
| D0120 |
Periodic oral evaluation - established patient |
9,462 |
9,425 |
$222K |
| D0140 |
Limited oral evaluation - problem focused |
6,951 |
6,750 |
$203K |
| D1206 |
Topical application of fluoride varnish |
8,607 |
8,573 |
$174K |
| D5110 |
|
162 |
162 |
$161K |
| D0274 |
Bitewings - four radiographic images |
5,740 |
5,719 |
$161K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,583 |
2,074 |
$153K |
| D2140 |
|
2,362 |
1,849 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,828 |
3,814 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
7,641 |
7,406 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,648 |
1,321 |
$77K |
| D1120 |
Prophylaxis - child |
2,959 |
2,952 |
$77K |
| D0330 |
Panoramic radiographic image |
981 |
980 |
$68K |
| D0272 |
Bitewings - two radiographic images |
2,583 |
2,568 |
$58K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
560 |
457 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
619 |
531 |
$30K |
| D2331 |
|
372 |
285 |
$29K |
| D5120 |
|
24 |
24 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,154 |
2,173 |
$23K |
| D2160 |
|
303 |
274 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,393 |
1,293 |
$19K |
| D2330 |
|
320 |
226 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
142 |
134 |
$9K |
| D1351 |
Sealant - per tooth |
405 |
126 |
$5K |
| D4355 |
|
12 |
12 |
$411.07 |
| D7111 |
|
22 |
12 |
$70.15 |