| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
8,458 |
3,247 |
$377K |
| D1110 |
Prophylaxis - adult |
3,591 |
3,429 |
$155K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,574 |
1,614 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,088 |
4,863 |
$134K |
| D0330 |
Panoramic radiographic image |
2,920 |
2,755 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
3,432 |
3,080 |
$100K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,170 |
689 |
$96K |
| D1120 |
Prophylaxis - child |
1,578 |
1,515 |
$75K |
| D0274 |
Bitewings - four radiographic images |
3,003 |
2,862 |
$74K |
| D2140 |
|
1,558 |
1,001 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,538 |
2,436 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
4,977 |
4,633 |
$38K |
| D2160 |
|
524 |
414 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,002 |
1,648 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
626 |
612 |
$15K |
| D5110 |
|
13 |
13 |
$8K |
| D1351 |
Sealant - per tooth |
422 |
109 |
$6K |
| D2335 |
|
58 |
42 |
$5K |
| D2330 |
|
99 |
69 |
$4K |
| D2331 |
|
82 |
68 |
$4K |
| D2332 |
|
47 |
38 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
40 |
27 |
$2K |
| D0272 |
Bitewings - two radiographic images |
64 |
58 |
$989.49 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$761.88 |
| D9986 |
|
85 |
79 |
$216.00 |