| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,611 |
5,471 |
$297K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,785 |
1,467 |
$262K |
| D1120 |
Prophylaxis - child |
3,851 |
3,810 |
$196K |
| D0120 |
Periodic oral evaluation - established patient |
7,638 |
7,513 |
$192K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,010 |
1,098 |
$183K |
| D0330 |
Panoramic radiographic image |
2,258 |
2,208 |
$149K |
| D0140 |
Limited oral evaluation - problem focused |
3,710 |
3,592 |
$142K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,658 |
4,607 |
$137K |
| D0274 |
Bitewings - four radiographic images |
3,325 |
3,227 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
7,084 |
6,831 |
$111K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
748 |
602 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,779 |
1,733 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,678 |
4,742 |
$72K |
| D2740 |
Crown - porcelain/ceramic |
88 |
69 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
497 |
353 |
$46K |
| D1351 |
Sealant - per tooth |
1,071 |
278 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
546 |
260 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,032 |
1,020 |
$31K |
| D2394 |
|
118 |
92 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
112 |
58 |
$10K |
| D9110 |
|
224 |
221 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
97 |
95 |
$7K |
| D2950 |
|
20 |
12 |
$3K |
| D2335 |
|
21 |
12 |
$3K |