| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,019 |
1,067 |
$194K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,141 |
1,145 |
$130K |
| D1110 |
Prophylaxis - adult |
2,825 |
2,788 |
$99K |
| D0274 |
Bitewings - four radiographic images |
3,068 |
3,039 |
$84K |
| D0330 |
Panoramic radiographic image |
2,218 |
2,197 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,687 |
2,666 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,740 |
2,703 |
$59K |
| D5214 |
|
69 |
69 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
650 |
423 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
426 |
325 |
$28K |
| D1351 |
Sealant - per tooth |
1,205 |
156 |
$28K |
| D1120 |
Prophylaxis - child |
843 |
832 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,386 |
1,368 |
$25K |
| D2331 |
|
371 |
247 |
$22K |
| D5213 |
|
36 |
36 |
$19K |
| D9110 |
|
222 |
218 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
595 |
580 |
$4K |
| D0272 |
Bitewings - two radiographic images |
152 |
148 |
$2K |
| D2332 |
|
27 |
24 |
$2K |
| D1330 |
|
29 |
29 |
$55.00 |