| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
4,482 |
4,027 |
$157K |
| D0330 |
Panoramic radiographic image |
1,824 |
1,781 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
4,176 |
4,103 |
$105K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,627 |
698 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
6,323 |
5,936 |
$94K |
| D0274 |
Bitewings - four radiographic images |
2,419 |
2,379 |
$77K |
| D4355 |
|
1,027 |
1,018 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,713 |
4,462 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
671 |
394 |
$67K |
| D1120 |
Prophylaxis - child |
2,379 |
2,318 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,738 |
3,663 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,343 |
1,309 |
$59K |
| D1110 |
Prophylaxis - adult |
1,404 |
1,384 |
$54K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
318 |
209 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
388 |
232 |
$29K |
| D9110 |
|
487 |
468 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,020 |
1,006 |
$19K |
| D7311 |
|
177 |
130 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
53 |
36 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
14 |
$2K |
| D1351 |
Sealant - per tooth |
54 |
12 |
$2K |