| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,313 |
2,122 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,257 |
1,378 |
$133K |
| D0274 |
Bitewings - four radiographic images |
4,380 |
4,300 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,408 |
2,377 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
2,909 |
2,846 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
826 |
601 |
$62K |
| D0330 |
Panoramic radiographic image |
2,478 |
2,467 |
$62K |
| D1110 |
Prophylaxis - adult |
2,204 |
2,156 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
962 |
689 |
$45K |
| D1120 |
Prophylaxis - child |
2,281 |
2,236 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,336 |
3,253 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,373 |
1,357 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,419 |
2,366 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,610 |
1,579 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
750 |
704 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,079 |
980 |
$8K |
| D1206 |
Topical application of fluoride varnish |
438 |
431 |
$5K |
| D1351 |
Sealant - per tooth |
76 |
18 |
$1K |
| D2335 |
|
17 |
13 |
$1K |
| D2950 |
|
13 |
12 |
$1K |