| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,754 |
2,047 |
$338K |
| D0330 |
Panoramic radiographic image |
3,599 |
3,152 |
$148K |
| D0140 |
Limited oral evaluation - problem focused |
4,047 |
3,301 |
$140K |
| D1120 |
Prophylaxis - child |
4,959 |
4,394 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,338 |
2,981 |
$105K |
| D1351 |
Sealant - per tooth |
4,060 |
447 |
$94K |
| D0272 |
Bitewings - two radiographic images |
4,844 |
4,309 |
$72K |
| D1206 |
Topical application of fluoride varnish |
3,113 |
2,709 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
4,986 |
4,334 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,590 |
1,421 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,767 |
3,244 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
418 |
226 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,607 |
1,512 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
722 |
616 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
44 |
24 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
41 |
$3K |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$110.00 |