| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,687 |
952 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
1,972 |
1,874 |
$54K |
| D1120 |
Prophylaxis - child |
1,313 |
1,273 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
808 |
610 |
$49K |
| D1110 |
Prophylaxis - adult |
878 |
859 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,255 |
1,215 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,745 |
1,653 |
$28K |
| D1351 |
Sealant - per tooth |
300 |
166 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,141 |
1,081 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
561 |
434 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,211 |
3,004 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,768 |
2,432 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
203 |
154 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
549 |
531 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
668 |
648 |
$12K |
| D5110 |
|
18 |
18 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
107 |
88 |
$8K |
| D4341 |
|
44 |
25 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
20 |
18 |
$5K |
| D2950 |
|
73 |
56 |
$4K |
| D2335 |
|
19 |
15 |
$2K |
| D0272 |
Bitewings - two radiographic images |
192 |
178 |
$2K |
| D0270 |
|
261 |
255 |
$1K |
| D2940 |
|
63 |
58 |
$783.20 |
| D1999 |
|
721 |
637 |
$0.00 |