| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
12,455 |
5,098 |
$981K |
| D1110 |
Prophylaxis - adult |
18,079 |
17,939 |
$946K |
| D0120 |
Periodic oral evaluation - established patient |
20,233 |
20,092 |
$633K |
| D1206 |
Topical application of fluoride varnish |
23,114 |
22,956 |
$613K |
| D0330 |
Panoramic radiographic image |
7,753 |
7,692 |
$548K |
| D0274 |
Bitewings - four radiographic images |
14,329 |
14,228 |
$532K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,994 |
4,538 |
$484K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,576 |
20,491 |
$432K |
| D0220 |
Intraoral - periapical first radiographic image |
28,082 |
27,418 |
$430K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,030 |
3,903 |
$327K |
| D0140 |
Limited oral evaluation - problem focused |
9,281 |
9,119 |
$317K |
| D1120 |
Prophylaxis - child |
8,249 |
8,194 |
$284K |
| D5110 |
|
344 |
341 |
$266K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,451 |
7,400 |
$258K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,393 |
1,771 |
$228K |
| D1330 |
|
8,603 |
8,480 |
$217K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,667 |
1,086 |
$182K |
| D2331 |
|
1,817 |
1,368 |
$162K |
| D2335 |
|
1,421 |
1,074 |
$151K |
| D2332 |
|
1,445 |
1,072 |
$145K |
| D1351 |
Sealant - per tooth |
4,624 |
1,520 |
$128K |
| D2160 |
|
1,041 |
855 |
$120K |
| D0272 |
Bitewings - two radiographic images |
3,559 |
3,526 |
$109K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,653 |
1,335 |
$108K |
| D2140 |
|
1,305 |
964 |
$95K |
| D2330 |
|
1,497 |
1,085 |
$95K |
| D5120 |
|
132 |
130 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,387 |
1,240 |
$29K |
| D2394 |
|
430 |
362 |
$28K |
| D4341 |
|
111 |
40 |
$25K |
| D5212 |
|
26 |
26 |
$22K |
| D2161 |
|
87 |
80 |
$12K |
| D5211 |
|
14 |
14 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
309 |
309 |
$9K |
| D4910 |
|
88 |
86 |
$7K |
| D0240 |
|
497 |
251 |
$5K |
| D0273 |
|
12 |
12 |
$561.43 |
| D0270 |
|
15 |
12 |
$178.17 |
| D9985 |
|
50 |
44 |
$19.68 |
| D4355 |
|
45 |
45 |
$0.00 |
| D3120 |
|
15 |
13 |
$0.00 |
| D9110 |
|
19 |
15 |
$0.00 |