| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,350 |
766 |
$551K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
886 |
442 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,000 |
334 |
$103K |
| D2740 |
Crown - porcelain/ceramic |
270 |
155 |
$101K |
| D1110 |
Prophylaxis - adult |
1,044 |
1,028 |
$68K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
376 |
193 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,028 |
1,018 |
$57K |
| D0330 |
Panoramic radiographic image |
1,128 |
1,115 |
$51K |
| D2332 |
|
200 |
84 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
825 |
814 |
$26K |
| D3320 |
|
32 |
27 |
$21K |
| D2950 |
|
192 |
108 |
$16K |
| D0272 |
Bitewings - two radiographic images |
914 |
898 |
$15K |
| D2330 |
|
133 |
53 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
127 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
117 |
116 |
$3K |
| D1120 |
Prophylaxis - child |
51 |
50 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
15 |
$177.30 |