| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
8,838 |
4,821 |
$729K |
| D1351 |
Sealant - per tooth |
14,083 |
3,105 |
$448K |
| D1110 |
Prophylaxis - adult |
6,795 |
6,751 |
$337K |
| D0330 |
Panoramic radiographic image |
3,600 |
3,584 |
$282K |
| D0120 |
Periodic oral evaluation - established patient |
8,667 |
8,630 |
$264K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,341 |
1,511 |
$257K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,483 |
8,445 |
$202K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,883 |
1,379 |
$183K |
| D0274 |
Bitewings - four radiographic images |
5,387 |
5,351 |
$182K |
| D1120 |
Prophylaxis - child |
5,546 |
5,526 |
$180K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,054 |
4,020 |
$153K |
| D0220 |
Intraoral - periapical first radiographic image |
10,216 |
10,071 |
$142K |
| D0140 |
Limited oral evaluation - problem focused |
3,865 |
3,789 |
$127K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,095 |
7,288 |
$122K |
| D1206 |
Topical application of fluoride varnish |
3,505 |
3,476 |
$89K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
982 |
739 |
$72K |
| D2330 |
|
974 |
573 |
$59K |
| D1330 |
|
1,944 |
1,921 |
$47K |
| D2335 |
|
238 |
163 |
$33K |
| D2140 |
|
240 |
170 |
$12K |
| D2331 |
|
120 |
84 |
$9K |