| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
14,846 |
6,418 |
$920K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,274 |
7,450 |
$906K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
11,436 |
6,187 |
$788K |
| D1110 |
Prophylaxis - adult |
15,833 |
15,252 |
$578K |
| D0274 |
Bitewings - four radiographic images |
23,586 |
22,627 |
$497K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,639 |
15,933 |
$469K |
| D0230 |
Intraoral - periapical each additional radiographic image |
50,042 |
25,921 |
$391K |
| D0120 |
Periodic oral evaluation - established patient |
21,163 |
20,339 |
$384K |
| D0210 |
Intraoral - complete series of radiographic images |
4,856 |
4,529 |
$257K |
| D2394 |
|
2,916 |
2,085 |
$220K |
| D0220 |
Intraoral - periapical first radiographic image |
32,590 |
30,961 |
$174K |
| D0140 |
Limited oral evaluation - problem focused |
7,246 |
6,952 |
$174K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,584 |
10,258 |
$167K |
| D2335 |
|
1,771 |
883 |
$166K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,312 |
1,157 |
$136K |
| D1120 |
Prophylaxis - child |
6,738 |
6,558 |
$135K |
| D0330 |
Panoramic radiographic image |
2,043 |
1,998 |
$91K |
| D7240 |
Removal of impacted tooth - completely bony |
325 |
117 |
$60K |
| D7310 |
|
582 |
414 |
$55K |
| D9243 |
|
871 |
331 |
$49K |
| D0240 |
|
3,280 |
1,947 |
$47K |
| D4341 |
|
574 |
219 |
$46K |
| D2160 |
|
569 |
333 |
$36K |
| D3320 |
|
129 |
108 |
$36K |
| D2332 |
|
406 |
239 |
$29K |
| D9239 |
|
362 |
346 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
419 |
239 |
$22K |
| D1351 |
Sealant - per tooth |
1,043 |
244 |
$22K |
| D4342 |
|
247 |
109 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
267 |
107 |
$15K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
40 |
38 |
$14K |
| D9610 |
|
369 |
354 |
$14K |
| D7230 |
|
92 |
39 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,300 |
1,275 |
$13K |
| D7220 |
|
128 |
94 |
$13K |
| D2331 |
|
135 |
88 |
$8K |
| D2161 |
|
89 |
57 |
$7K |
| D5214 |
|
13 |
12 |
$6K |
| D5213 |
|
12 |
12 |
$6K |
| D1320 |
|
169 |
166 |
$3K |