| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,781 |
2,823 |
$359K |
| D0330 |
Panoramic radiographic image |
5,573 |
5,264 |
$227K |
| D0140 |
Limited oral evaluation - problem focused |
6,499 |
6,062 |
$178K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,288 |
1,525 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,177 |
5,914 |
$154K |
| D1120 |
Prophylaxis - child |
3,157 |
3,049 |
$138K |
| D1110 |
Prophylaxis - adult |
2,571 |
2,429 |
$107K |
| D7250 |
|
1,188 |
490 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,277 |
2,157 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,928 |
2,821 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
4,300 |
4,004 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
631 |
389 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,146 |
2,376 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
396 |
215 |
$18K |
| D0272 |
Bitewings - two radiographic images |
755 |
719 |
$12K |
| D1206 |
Topical application of fluoride varnish |
751 |
728 |
$11K |
| D9110 |
|
650 |
593 |
$11K |
| D1351 |
Sealant - per tooth |
621 |
186 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
177 |
125 |
$11K |
| D5214 |
|
14 |
12 |
$7K |
| D2335 |
|
86 |
50 |
$7K |
| D2332 |
|
46 |
28 |
$3K |
| D4341 |
|
40 |
14 |
$2K |
| D2394 |
|
34 |
29 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
128 |
111 |
$1K |
| D7510 |
|
12 |
12 |
$520.00 |