| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,067 |
1,150 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,094 |
730 |
$83K |
| D1351 |
Sealant - per tooth |
1,027 |
443 |
$83K |
| D4341 |
|
553 |
219 |
$81K |
| D1120 |
Prophylaxis - child |
1,669 |
1,669 |
$70K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
654 |
425 |
$70K |
| D2332 |
|
511 |
362 |
$63K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
547 |
444 |
$56K |
| D1110 |
Prophylaxis - adult |
1,150 |
1,150 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,065 |
2,064 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,540 |
1,538 |
$44K |
| D0274 |
Bitewings - four radiographic images |
2,162 |
2,159 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,569 |
1,568 |
$42K |
| D2335 |
|
272 |
197 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
580 |
440 |
$29K |
| D5110 |
|
52 |
51 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,941 |
2,932 |
$19K |
| D9110 |
|
305 |
303 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,738 |
2,734 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
757 |
747 |
$12K |
| D5120 |
|
26 |
26 |
$11K |
| D4342 |
|
64 |
36 |
$7K |
| D0330 |
Panoramic radiographic image |
337 |
337 |
$7K |
| D0272 |
Bitewings - two radiographic images |
508 |
508 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
172 |
172 |
$4K |
| D2330 |
|
46 |
32 |
$3K |
| D4910 |
|
29 |
29 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
53 |
53 |
$1K |
| D2394 |
|
13 |
12 |
$1K |