| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
11,920 |
4,529 |
$804K |
| D4341 |
|
4,545 |
1,493 |
$659K |
| D1351 |
Sealant - per tooth |
10,050 |
3,968 |
$645K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,435 |
2,608 |
$526K |
| D0120 |
Periodic oral evaluation - established patient |
15,242 |
14,033 |
$406K |
| D1120 |
Prophylaxis - child |
9,609 |
9,031 |
$377K |
| D5110 |
|
868 |
835 |
$346K |
| D5120 |
|
686 |
656 |
$273K |
| D1110 |
Prophylaxis - adult |
5,804 |
5,409 |
$237K |
| D1206 |
Topical application of fluoride varnish |
8,797 |
8,284 |
$219K |
| D4342 |
|
1,050 |
771 |
$212K |
| D0274 |
Bitewings - four radiographic images |
7,969 |
7,545 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,396 |
1,173 |
$121K |
| D0330 |
Panoramic radiographic image |
5,308 |
4,869 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,359 |
4,100 |
$94K |
| D2332 |
|
937 |
513 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
14,672 |
13,477 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,971 |
12,814 |
$55K |
| D0272 |
Bitewings - two radiographic images |
3,406 |
3,131 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
308 |
187 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
762 |
715 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
142 |
122 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
622 |
615 |
$11K |
| D2331 |
|
76 |
56 |
$7K |
| D0270 |
|
1,161 |
1,027 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
13 |
$4K |
| D2330 |
|
74 |
47 |
$4K |
| D9110 |
|
13 |
12 |
$715.00 |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
50 |
$149.30 |
| D1999 |
|
456 |
429 |
$0.00 |