| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
7,600 |
2,534 |
$899K |
| D1110 |
Prophylaxis - adult |
5,112 |
5,064 |
$362K |
| D8670 |
Periodic orthodontic treatment visit |
1,464 |
1,464 |
$341K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,375 |
1,635 |
$310K |
| D2140 |
|
1,645 |
1,161 |
$145K |
| D0274 |
Bitewings - four radiographic images |
2,940 |
2,909 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
4,919 |
4,875 |
$123K |
| D1120 |
Prophylaxis - child |
2,083 |
2,067 |
$94K |
| D2331 |
|
550 |
376 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
3,864 |
3,756 |
$91K |
| D2160 |
|
519 |
413 |
$80K |
| D9239 |
|
282 |
277 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,930 |
1,585 |
$54K |
| D7230 |
|
167 |
77 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,162 |
3,134 |
$48K |
| D2330 |
|
359 |
248 |
$35K |
| D9243 |
|
683 |
274 |
$32K |
| D0272 |
Bitewings - two radiographic images |
906 |
899 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
174 |
125 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
33 |
$11K |
| D7240 |
Removal of impacted tooth - completely bony |
28 |
13 |
$11K |
| D1351 |
Sealant - per tooth |
517 |
157 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
200 |
200 |
$3K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$1K |
| D2332 |
|
19 |
12 |
$173.80 |
| D7220 |
|
23 |
14 |
$0.00 |