| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,622 |
1,232 |
$243K |
| D0330 |
Panoramic radiographic image |
2,759 |
2,376 |
$109K |
| D0140 |
Limited oral evaluation - problem focused |
3,024 |
2,424 |
$97K |
| D0274 |
Bitewings - four radiographic images |
4,347 |
3,698 |
$85K |
| D1120 |
Prophylaxis - child |
3,410 |
2,910 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,540 |
2,152 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,141 |
2,668 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
357 |
169 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,020 |
890 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,616 |
1,959 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
167 |
66 |
$15K |
| D2140 |
|
139 |
81 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
112 |
49 |
$6K |
| D2160 |
|
49 |
30 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
59 |
$4K |
| D1351 |
Sealant - per tooth |
212 |
59 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$3K |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$650.00 |
| D1999 |
|
78 |
74 |
$0.00 |