| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,846 |
1,072 |
$171K |
| D1110 |
Prophylaxis - adult |
2,198 |
1,705 |
$78K |
| D1206 |
Topical application of fluoride varnish |
4,987 |
3,842 |
$78K |
| D0330 |
Panoramic radiographic image |
1,463 |
1,226 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
2,748 |
2,223 |
$65K |
| D1120 |
Prophylaxis - child |
2,905 |
2,258 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
3,303 |
2,611 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,050 |
1,564 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,607 |
2,050 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
499 |
285 |
$27K |
| D1351 |
Sealant - per tooth |
1,014 |
288 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
381 |
248 |
$22K |
| D2140 |
|
395 |
249 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,356 |
1,075 |
$14K |
| D1354 |
|
904 |
317 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,685 |
2,124 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
227 |
154 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,730 |
529 |
$9K |
| D0180 |
|
24 |
12 |
$664.08 |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
14 |
$235.91 |