| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,209 |
1,186 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,043 |
3,917 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,843 |
1,164 |
$95K |
| D1110 |
Prophylaxis - adult |
2,528 |
2,465 |
$94K |
| D0330 |
Panoramic radiographic image |
2,522 |
2,442 |
$87K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,308 |
516 |
$82K |
| D4341 |
|
1,051 |
437 |
$70K |
| D0274 |
Bitewings - four radiographic images |
2,796 |
2,714 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
934 |
646 |
$55K |
| D1120 |
Prophylaxis - child |
1,193 |
1,152 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,526 |
1,490 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
384 |
281 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,222 |
2,088 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,228 |
1,123 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
313 |
304 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
347 |
343 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
548 |
528 |
$7K |
| D2394 |
|
98 |
76 |
$7K |
| D1351 |
Sealant - per tooth |
401 |
120 |
$7K |
| D0272 |
Bitewings - two radiographic images |
454 |
427 |
$7K |
| D2335 |
|
76 |
44 |
$6K |
| D2332 |
|
33 |
25 |
$2K |