| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,760 |
804 |
$358K |
| D2740 |
Crown - porcelain/ceramic |
450 |
200 |
$309K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,966 |
1,948 |
$78K |
| D0330 |
Panoramic radiographic image |
1,331 |
1,324 |
$68K |
| D5110 |
|
60 |
60 |
$47K |
| D5120 |
|
53 |
53 |
$42K |
| D0383 |
|
277 |
276 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,122 |
1,094 |
$39K |
| D2950 |
|
271 |
117 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
1,636 |
1,594 |
$20K |
| D1110 |
Prophylaxis - adult |
320 |
315 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
267 |
257 |
$13K |
| D4341 |
|
43 |
12 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
447 |
443 |
$11K |
| D5130 |
|
13 |
13 |
$10K |
| D9243 |
|
13 |
13 |
$9K |
| D0274 |
Bitewings - four radiographic images |
305 |
300 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
419 |
407 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
28 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$3K |
| D0350 |
|
62 |
62 |
$2K |
| D0170 |
|
52 |
52 |
$2K |
| D9239 |
|
13 |
13 |
$1K |