| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
14,819 |
7,529 |
$806K |
| D0140 |
Limited oral evaluation - problem focused |
12,354 |
12,084 |
$350K |
| D0220 |
Intraoral - periapical first radiographic image |
13,431 |
13,064 |
$148K |
| D1110 |
Prophylaxis - adult |
3,641 |
3,585 |
$144K |
| D0210 |
Intraoral - complete series of radiographic images |
2,248 |
2,210 |
$129K |
| D1206 |
Topical application of fluoride varnish |
7,696 |
7,516 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
6,379 |
6,272 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,842 |
3,759 |
$100K |
| D0460 |
|
9,084 |
8,866 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
794 |
654 |
$77K |
| D0274 |
Bitewings - four radiographic images |
2,950 |
2,884 |
$68K |
| D4910 |
|
874 |
862 |
$52K |
| D1120 |
Prophylaxis - child |
1,673 |
1,613 |
$48K |
| D4341 |
|
660 |
211 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
538 |
403 |
$32K |
| D0330 |
Panoramic radiographic image |
1,151 |
1,127 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
211 |
156 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,504 |
997 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
96 |
80 |
$8K |
| D2950 |
|
72 |
64 |
$8K |
| D1351 |
Sealant - per tooth |
319 |
67 |
$7K |
| D0272 |
Bitewings - two radiographic images |
180 |
172 |
$3K |
| D3221 |
|
18 |
18 |
$1K |
| D2140 |
|
29 |
26 |
$1K |
| D0240 |
|
39 |
27 |
$648.04 |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
28 |
$588.50 |