| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,957 |
3,401 |
$613K |
| D0140 |
Limited oral evaluation - problem focused |
6,174 |
5,826 |
$544K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,736 |
3,123 |
$503K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,477 |
5,375 |
$422K |
| D1110 |
Prophylaxis - adult |
5,453 |
5,381 |
$399K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,398 |
2,711 |
$371K |
| D0120 |
Periodic oral evaluation - established patient |
5,905 |
5,855 |
$274K |
| D1120 |
Prophylaxis - child |
4,139 |
4,098 |
$161K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
880 |
810 |
$142K |
| D2940 |
|
1,244 |
1,024 |
$133K |
| D1206 |
Topical application of fluoride varnish |
5,228 |
5,076 |
$119K |
| D1351 |
Sealant - per tooth |
3,779 |
802 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
3,923 |
3,624 |
$94K |
| D2331 |
|
587 |
476 |
$70K |
| D5110 |
|
75 |
75 |
$62K |
| D0330 |
Panoramic radiographic image |
3,107 |
3,056 |
$51K |
| D0274 |
Bitewings - four radiographic images |
3,708 |
3,658 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
7,591 |
7,300 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
290 |
247 |
$43K |
| D2330 |
|
306 |
236 |
$31K |
| D4355 |
|
240 |
232 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,279 |
1,261 |
$18K |
| D0270 |
|
2,800 |
2,713 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,769 |
2,830 |
$12K |
| D5120 |
|
12 |
12 |
$5K |
| D2332 |
|
30 |
25 |
$3K |
| D2335 |
|
19 |
19 |
$3K |
| D0191 |
|
54 |
54 |
$2K |
| D2140 |
|
17 |
15 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
81 |
65 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$868.60 |
| D0603 |
|
109 |
106 |
$0.00 |
| D9995 |
|
215 |
208 |
$0.00 |
| D9986 |
|
81 |
80 |
$0.00 |
| D9987 |
|
13 |
13 |
$0.00 |