| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,745 |
602 |
$210K |
| D2740 |
Crown - porcelain/ceramic |
379 |
269 |
$185K |
| D0330 |
Panoramic radiographic image |
1,876 |
1,776 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,137 |
681 |
$74K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
970 |
591 |
$70K |
| D1110 |
Prophylaxis - adult |
1,386 |
1,291 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,090 |
1,948 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,667 |
1,569 |
$38K |
| D5110 |
|
63 |
60 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
702 |
675 |
$27K |
| D2332 |
|
342 |
212 |
$24K |
| D2950 |
|
257 |
188 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
161 |
92 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
479 |
460 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,913 |
1,703 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,090 |
959 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
14 |
$7K |
| D5120 |
|
12 |
12 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
163 |
153 |
$3K |
| D2335 |
|
18 |
17 |
$2K |
| D2394 |
|
18 |
13 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
78 |
76 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
208 |
52 |
$1K |
| D1120 |
Prophylaxis - child |
21 |
14 |
$841.82 |
| D9986 |
|
58 |
55 |
$165.00 |
| D9987 |
|
12 |
12 |
$21.00 |