| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
7,597 |
2,447 |
$944K |
| D1351 |
Sealant - per tooth |
18,021 |
4,891 |
$611K |
| D1206 |
Topical application of fluoride varnish |
21,036 |
20,452 |
$518K |
| D1120 |
Prophylaxis - child |
10,550 |
10,301 |
$459K |
| D0120 |
Periodic oral evaluation - established patient |
10,651 |
10,408 |
$314K |
| D0140 |
Limited oral evaluation - problem focused |
6,295 |
5,731 |
$275K |
| D1110 |
Prophylaxis - adult |
3,966 |
3,875 |
$240K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,693 |
1,164 |
$216K |
| D0330 |
Panoramic radiographic image |
4,872 |
4,729 |
$212K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,719 |
1,117 |
$171K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,381 |
2,317 |
$126K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
485 |
264 |
$72K |
| D1330 |
|
11,748 |
11,341 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,610 |
2,547 |
$59K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,440 |
1,394 |
$58K |
| D0272 |
Bitewings - two radiographic images |
2,423 |
2,377 |
$37K |
| D7220 |
|
196 |
137 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,835 |
1,764 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
705 |
689 |
$9K |
| D2330 |
|
54 |
41 |
$5K |
| D2332 |
|
17 |
12 |
$2K |
| D2331 |
|
16 |
13 |
$2K |
| D1354 |
|
31 |
13 |
$310.00 |
| D9910 |
|
18 |
18 |
$180.00 |