| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,464 |
357 |
$90K |
| D8670 |
Periodic orthodontic treatment visit |
378 |
366 |
$82K |
| D1110 |
Prophylaxis - adult |
1,845 |
1,833 |
$61K |
| D1351 |
Sealant - per tooth |
2,373 |
416 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,941 |
1,933 |
$37K |
| D0330 |
Panoramic radiographic image |
1,052 |
1,033 |
$35K |
| D1120 |
Prophylaxis - child |
872 |
868 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
526 |
276 |
$25K |
| D0274 |
Bitewings - four radiographic images |
912 |
904 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,263 |
1,260 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
865 |
853 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
261 |
158 |
$15K |
| D0272 |
Bitewings - two radiographic images |
500 |
496 |
$8K |
| D2330 |
|
55 |
27 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
313 |
301 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34 |
34 |
$1K |
| D2332 |
|
23 |
14 |
$1K |
| D8660 |
|
13 |
13 |
$1K |
| D2331 |
|
17 |
12 |
$1K |