| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,092 |
1,427 |
$229K |
| D0330 |
Panoramic radiographic image |
3,789 |
3,726 |
$215K |
| D0140 |
Limited oral evaluation - problem focused |
7,898 |
7,062 |
$200K |
| D1110 |
Prophylaxis - adult |
4,366 |
4,286 |
$178K |
| D0274 |
Bitewings - four radiographic images |
4,644 |
4,570 |
$129K |
| D1206 |
Topical application of fluoride varnish |
4,230 |
4,162 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,926 |
2,868 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
7,594 |
7,290 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,796 |
5,537 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,645 |
740 |
$61K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
628 |
374 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,763 |
1,737 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
655 |
428 |
$33K |
| D1330 |
|
4,741 |
4,632 |
$33K |
| D1354 |
|
969 |
241 |
$29K |
| D1351 |
Sealant - per tooth |
1,352 |
157 |
$29K |
| D1120 |
Prophylaxis - child |
625 |
623 |
$21K |
| D4355 |
|
459 |
453 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
155 |
107 |
$12K |
| D2330 |
|
182 |
111 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
160 |
133 |
$8K |
| D2140 |
|
87 |
60 |
$5K |
| D2332 |
|
52 |
33 |
$5K |
| D0272 |
Bitewings - two radiographic images |
150 |
149 |
$4K |
| D9110 |
|
108 |
98 |
$2K |
| D2335 |
|
70 |
48 |
$2K |
| D2331 |
|
24 |
12 |
$2K |
| D2394 |
|
30 |
26 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
62 |
61 |
$707.31 |
| D9985 |
|
81 |
74 |
$102.09 |
| D0602 |
|
43 |
40 |
$0.00 |
| D0601 |
|
24 |
24 |
$0.00 |
| D0603 |
|
132 |
132 |
$0.00 |
| D5212 |
|
12 |
12 |
$0.00 |