| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
22,610 |
3,923 |
$787K |
| D0330 |
Panoramic radiographic image |
8,123 |
7,913 |
$573K |
| D0140 |
Limited oral evaluation - problem focused |
16,585 |
14,929 |
$560K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,747 |
2,328 |
$511K |
| D1110 |
Prophylaxis - adult |
8,080 |
7,851 |
$442K |
| D0274 |
Bitewings - four radiographic images |
11,076 |
10,871 |
$401K |
| D0220 |
Intraoral - periapical first radiographic image |
15,361 |
14,714 |
$216K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,301 |
5,120 |
$193K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,317 |
12,321 |
$193K |
| D1206 |
Topical application of fluoride varnish |
6,883 |
6,660 |
$184K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,706 |
1,206 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
4,323 |
4,293 |
$141K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
911 |
534 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,579 |
874 |
$94K |
| D2140 |
|
1,372 |
822 |
$92K |
| D1120 |
Prophylaxis - child |
1,994 |
1,987 |
$80K |
| D5227 |
|
29 |
29 |
$74K |
| D1330 |
|
9,105 |
8,834 |
$73K |
| D4355 |
|
1,107 |
1,066 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
655 |
427 |
$52K |
| D9110 |
|
922 |
889 |
$44K |
| D2330 |
|
664 |
346 |
$42K |
| D2160 |
|
336 |
279 |
$36K |
| D2331 |
|
266 |
176 |
$26K |
| D2332 |
|
172 |
100 |
$19K |
| D0240 |
|
369 |
187 |
$15K |
| D5212 |
|
14 |
14 |
$10K |
| D2335 |
|
88 |
68 |
$9K |
| D5228 |
|
16 |
16 |
$7K |
| D5211 |
|
16 |
12 |
$7K |
| D1351 |
Sealant - per tooth |
206 |
21 |
$4K |
| D0272 |
Bitewings - two radiographic images |
101 |
101 |
$3K |
| D7111 |
|
14 |
12 |
$1K |
| D9985 |
|
254 |
225 |
$398.52 |
| D5410 |
|
18 |
14 |
$324.12 |
| D2940 |
|
12 |
12 |
$299.03 |
| D5411 |
|
17 |
14 |
$288.20 |