| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
8,679 |
2,739 |
$564K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,908 |
1,670 |
$298K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,846 |
5,568 |
$282K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,036 |
1,226 |
$266K |
| D1110 |
Prophylaxis - adult |
4,799 |
4,032 |
$207K |
| D0120 |
Periodic oral evaluation - established patient |
7,484 |
6,359 |
$184K |
| D0330 |
Panoramic radiographic image |
5,052 |
4,176 |
$167K |
| D0274 |
Bitewings - four radiographic images |
6,393 |
4,819 |
$139K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,147 |
592 |
$118K |
| D0210 |
Intraoral - complete series of radiographic images |
2,618 |
2,215 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
917 |
434 |
$61K |
| D1120 |
Prophylaxis - child |
1,640 |
1,622 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,624 |
2,578 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,620 |
2,595 |
$52K |
| D5110 |
|
70 |
62 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
637 |
620 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,489 |
1,316 |
$18K |
| D1351 |
Sealant - per tooth |
288 |
79 |
$8K |
| D7250 |
|
21 |
12 |
$3K |
| D4355 |
|
24 |
24 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
92 |
73 |
$642.99 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$461.88 |