| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,183 |
1,716 |
$409K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,925 |
1,550 |
$392K |
| D2740 |
Crown - porcelain/ceramic |
563 |
351 |
$337K |
| D1110 |
Prophylaxis - adult |
5,020 |
4,924 |
$212K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,923 |
4,830 |
$194K |
| D0140 |
Limited oral evaluation - problem focused |
5,664 |
5,562 |
$193K |
| D0330 |
Panoramic radiographic image |
3,202 |
3,151 |
$166K |
| D0274 |
Bitewings - four radiographic images |
4,842 |
4,767 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
5,628 |
5,546 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
7,751 |
7,560 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,625 |
2,581 |
$83K |
| D4342 |
|
891 |
379 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
766 |
404 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
2,540 |
2,468 |
$73K |
| D4341 |
|
328 |
142 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
323 |
216 |
$53K |
| D2950 |
|
299 |
185 |
$39K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
57 |
49 |
$25K |
| D2332 |
|
22 |
12 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
13 |
$3K |
| D1206 |
Topical application of fluoride varnish |
37 |
36 |
$794.96 |
| D0460 |
|
20 |
12 |
$536.80 |