| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,200 |
559 |
$136K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,171 |
660 |
$70K |
| D1110 |
Prophylaxis - adult |
1,438 |
1,431 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
687 |
444 |
$45K |
| D1351 |
Sealant - per tooth |
1,715 |
192 |
$42K |
| D0330 |
Panoramic radiographic image |
1,119 |
1,112 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,352 |
1,348 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,372 |
1,363 |
$27K |
| D2332 |
|
415 |
221 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,343 |
1,340 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
383 |
258 |
$19K |
| D1206 |
Topical application of fluoride varnish |
989 |
984 |
$17K |
| D1120 |
Prophylaxis - child |
533 |
531 |
$16K |
| D1330 |
|
1,023 |
1,023 |
$12K |
| D1310 |
|
1,037 |
1,037 |
$12K |
| D9110 |
|
399 |
391 |
$11K |
| D5120 |
|
12 |
12 |
$6K |
| D5110 |
|
12 |
12 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
890 |
877 |
$5K |
| D0272 |
Bitewings - two radiographic images |
264 |
261 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
155 |
143 |
$1K |