| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
15,328 |
3,083 |
$665K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,277 |
1,430 |
$173K |
| D0330 |
Panoramic radiographic image |
4,226 |
3,518 |
$162K |
| D1110 |
Prophylaxis - adult |
4,255 |
4,193 |
$158K |
| D1120 |
Prophylaxis - child |
3,242 |
3,219 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,068 |
5,027 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
5,169 |
5,116 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,179 |
812 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
4,491 |
3,378 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,559 |
2,343 |
$63K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
526 |
348 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,990 |
1,964 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
4,355 |
3,276 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
2,706 |
1,856 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
289 |
153 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,133 |
899 |
$22K |
| D0272 |
Bitewings - two radiographic images |
406 |
402 |
$8K |
| D1206 |
Topical application of fluoride varnish |
315 |
315 |
$6K |
| D1351 |
Sealant - per tooth |
70 |
25 |
$2K |