| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,244 |
739 |
$207K |
| D1110 |
Prophylaxis - adult |
3,646 |
3,434 |
$194K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,323 |
1,140 |
$187K |
| D0210 |
Intraoral - complete series of radiographic images |
2,790 |
2,550 |
$175K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,320 |
3,095 |
$134K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,362 |
740 |
$132K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
703 |
418 |
$127K |
| D1351 |
Sealant - per tooth |
3,447 |
502 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,407 |
719 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,749 |
2,884 |
$68K |
| D0274 |
Bitewings - four radiographic images |
1,823 |
1,720 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,544 |
2,408 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
3,743 |
3,450 |
$41K |
| D1120 |
Prophylaxis - child |
971 |
903 |
$33K |
| D2394 |
|
257 |
157 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
752 |
687 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
984 |
931 |
$20K |
| D1206 |
Topical application of fluoride varnish |
705 |
651 |
$15K |
| D0330 |
Panoramic radiographic image |
103 |
97 |
$6K |
| D4346 |
|
55 |
54 |
$6K |
| D0272 |
Bitewings - two radiographic images |
15 |
14 |
$322.53 |