| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,492 |
1,783 |
$388K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
612 |
303 |
$354K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
590 |
443 |
$336K |
| D0140 |
Limited oral evaluation - problem focused |
4,286 |
3,891 |
$249K |
| D1110 |
Prophylaxis - adult |
4,558 |
4,529 |
$172K |
| D0120 |
Periodic oral evaluation - established patient |
4,613 |
4,578 |
$98K |
| D0274 |
Bitewings - four radiographic images |
3,050 |
3,025 |
$92K |
| D0330 |
Panoramic radiographic image |
2,266 |
2,242 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,156 |
839 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
772 |
596 |
$56K |
| D1320 |
|
1,734 |
1,715 |
$36K |
| D3310 |
|
100 |
37 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
586 |
407 |
$32K |
| D7310 |
|
872 |
629 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,277 |
1,269 |
$26K |
| D3320 |
|
54 |
40 |
$24K |
| D1330 |
|
2,086 |
2,064 |
$23K |
| D1310 |
|
2,089 |
2,067 |
$23K |
| D5110 |
|
41 |
40 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
713 |
710 |
$14K |
| D0272 |
Bitewings - two radiographic images |
661 |
659 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,073 |
1,059 |
$9K |
| D1120 |
Prophylaxis - child |
284 |
284 |
$9K |
| D4346 |
|
178 |
173 |
$9K |
| D2332 |
|
105 |
67 |
$8K |
| D5120 |
|
12 |
12 |
$6K |
| D9110 |
|
208 |
206 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
495 |
484 |
$5K |
| D2330 |
|
44 |
25 |
$2K |
| D2394 |
|
23 |
19 |
$2K |
| D2335 |
|
15 |
12 |
$975.00 |