| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,454 |
2,207 |
$252K |
| D1110 |
Prophylaxis - adult |
3,254 |
3,230 |
$121K |
| D9630 |
|
6,963 |
6,022 |
$103K |
| D0274 |
Bitewings - four radiographic images |
3,347 |
3,325 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,960 |
2,436 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
3,688 |
2,910 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
2,101 |
2,034 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
7,045 |
5,310 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
561 |
427 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,704 |
2,641 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
515 |
344 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,967 |
1,953 |
$35K |
| D2335 |
|
326 |
207 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,958 |
1,952 |
$30K |
| D0330 |
Panoramic radiographic image |
957 |
592 |
$29K |
| D1120 |
Prophylaxis - child |
619 |
606 |
$19K |
| D9920 |
|
274 |
241 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
108 |
88 |
$10K |
| D2394 |
|
62 |
51 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
187 |
134 |
$8K |
| D9994 |
|
1,134 |
1,132 |
$7K |
| D0272 |
Bitewings - two radiographic images |
215 |
215 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
109 |
104 |
$2K |
| D1351 |
Sealant - per tooth |
60 |
18 |
$2K |
| D2332 |
|
35 |
25 |
$2K |