| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,533 |
2,541 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,836 |
2,177 |
$9K |
| D1110 |
Prophylaxis - adult |
4,054 |
3,984 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,737 |
2,292 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,301 |
4,243 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
5,969 |
5,818 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
2,632 |
2,602 |
$5K |
| D1206 |
Topical application of fluoride varnish |
4,672 |
4,591 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
9,621 |
9,377 |
$3K |
| D1354 |
|
12,260 |
4,461 |
$3K |
| D0274 |
Bitewings - four radiographic images |
3,163 |
3,132 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
2,970 |
2,916 |
$2K |
| D1120 |
Prophylaxis - child |
1,818 |
1,799 |
$2K |
| D1351 |
Sealant - per tooth |
865 |
274 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,053 |
4,505 |
$2K |
| D0603 |
|
4,357 |
4,240 |
$1K |
| D2940 |
|
826 |
721 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
288 |
271 |
$1K |
| D0601 |
|
2,247 |
2,182 |
$675.00 |
| D4910 |
|
251 |
249 |
$630.00 |
| D0270 |
|
1,851 |
1,816 |
$436.72 |
| D0602 |
|
1,295 |
1,275 |
$341.25 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,675 |
1,655 |
$266.00 |
| D0170 |
|
408 |
390 |
$190.00 |
| D0272 |
Bitewings - two radiographic images |
174 |
173 |
$87.00 |
| D1330 |
|
6,836 |
6,743 |
$54.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$43.00 |
| D1999 |
|
155 |
134 |
$0.00 |
| D0191 |
|
111 |
110 |
$0.00 |
| D0180 |
|
122 |
121 |
$0.00 |
| D4341 |
|
92 |
41 |
$0.00 |
| D4355 |
|
41 |
41 |
$0.00 |
| D1320 |
|
27 |
27 |
$0.00 |