| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
15,259 |
13,946 |
$414K |
| D0330 |
Panoramic radiographic image |
5,087 |
4,799 |
$275K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,665 |
1,490 |
$272K |
| D0274 |
Bitewings - four radiographic images |
8,105 |
7,817 |
$246K |
| D1110 |
Prophylaxis - adult |
6,724 |
6,522 |
$219K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,739 |
1,679 |
$203K |
| D1120 |
Prophylaxis - child |
4,506 |
4,426 |
$194K |
| D0120 |
Periodic oral evaluation - established patient |
7,488 |
7,342 |
$190K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,524 |
8,341 |
$186K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,435 |
1,010 |
$133K |
| D0220 |
Intraoral - periapical first radiographic image |
9,644 |
9,019 |
$104K |
| D9613 |
|
547 |
491 |
$101K |
| D8670 |
Periodic orthodontic treatment visit |
1,235 |
1,129 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,459 |
877 |
$91K |
| D2394 |
|
706 |
470 |
$87K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,035 |
415 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,796 |
1,445 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,092 |
1,065 |
$54K |
| D7250 |
|
316 |
183 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,638 |
2,643 |
$44K |
| D1351 |
Sealant - per tooth |
575 |
132 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
297 |
210 |
$17K |
| D2332 |
|
166 |
98 |
$15K |
| D2940 |
|
379 |
190 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
18 |
12 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
22 |
13 |
$8K |
| D0272 |
Bitewings - two radiographic images |
271 |
268 |
$8K |
| D0191 |
|
222 |
206 |
$7K |
| D3110 |
|
74 |
38 |
$7K |
| D2140 |
|
89 |
67 |
$4K |
| D2335 |
|
18 |
12 |
$2K |
| D2950 |
|
36 |
24 |
$2K |
| D2160 |
|
18 |
13 |
$1K |