| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
16,941 |
5,667 |
$1.09M |
| D0330 |
Panoramic radiographic image |
11,565 |
10,387 |
$578K |
| D1110 |
Prophylaxis - adult |
10,945 |
9,933 |
$412K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,770 |
10,576 |
$345K |
| D2335 |
|
2,274 |
848 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
5,593 |
5,063 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,133 |
4,507 |
$91K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,450 |
775 |
$90K |
| D1120 |
Prophylaxis - child |
3,762 |
3,337 |
$85K |
| D0274 |
Bitewings - four radiographic images |
3,843 |
3,468 |
$83K |
| D7220 |
|
837 |
579 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,274 |
745 |
$81K |
| D5110 |
|
139 |
133 |
$63K |
| D2332 |
|
673 |
259 |
$44K |
| D2931 |
|
366 |
305 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,577 |
1,373 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
534 |
279 |
$31K |
| D5120 |
|
63 |
60 |
$30K |
| D0272 |
Bitewings - two radiographic images |
879 |
842 |
$8K |
| D3320 |
|
14 |
12 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
687 |
621 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
12 |
$95.00 |
| D0601 |
|
316 |
211 |
$0.00 |
| D0602 |
|
13 |
12 |
$0.00 |