| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,032 |
952 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
630 |
111 |
$40K |
| D1110 |
Prophylaxis - adult |
1,007 |
1,001 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,161 |
1,154 |
$30K |
| D0330 |
Panoramic radiographic image |
820 |
815 |
$28K |
| D1351 |
Sealant - per tooth |
1,069 |
190 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
344 |
186 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
360 |
181 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
248 |
136 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
856 |
851 |
$16K |
| D1330 |
|
1,167 |
1,158 |
$12K |
| D1310 |
|
1,168 |
1,159 |
$12K |
| D2332 |
|
194 |
113 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
600 |
599 |
$12K |
| D2160 |
|
156 |
86 |
$10K |
| D1206 |
Topical application of fluoride varnish |
368 |
364 |
$7K |
| D1120 |
Prophylaxis - child |
193 |
192 |
$6K |
| D1321 |
|
364 |
304 |
$5K |
| D9920 |
|
29 |
29 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
660 |
651 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
158 |
158 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
40 |
$3K |
| D9110 |
|
99 |
98 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
258 |
257 |
$2K |
| D2335 |
|
18 |
12 |
$1K |