| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,903 |
824 |
$148K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,648 |
831 |
$123K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,467 |
3,637 |
$116K |
| D0330 |
Panoramic radiographic image |
3,352 |
2,061 |
$103K |
| D1110 |
Prophylaxis - adult |
3,094 |
2,956 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,822 |
3,548 |
$94K |
| D0274 |
Bitewings - four radiographic images |
4,606 |
4,305 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
4,673 |
4,346 |
$66K |
| D5214 |
|
137 |
131 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
2,329 |
1,798 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
709 |
417 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
6,329 |
3,989 |
$37K |
| D5110 |
|
66 |
66 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,338 |
1,328 |
$26K |
| D1120 |
Prophylaxis - child |
798 |
787 |
$24K |
| D2750 |
|
84 |
36 |
$22K |
| D5213 |
|
39 |
39 |
$20K |
| D4355 |
|
103 |
100 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
137 |
112 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
103 |
24 |
$6K |
| D2331 |
|
76 |
50 |
$4K |
| D2950 |
|
26 |
14 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
43 |
$918.72 |
| D2330 |
|
20 |
12 |
$0.00 |