| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
16,052 |
6,658 |
$901K |
| D0210 |
Intraoral - complete series of radiographic images |
10,874 |
10,666 |
$586K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,552 |
5,795 |
$554K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,026 |
13,762 |
$362K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,522 |
3,273 |
$349K |
| D1110 |
Prophylaxis - adult |
7,722 |
7,637 |
$250K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,186 |
2,385 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
10,315 |
10,179 |
$170K |
| D0274 |
Bitewings - four radiographic images |
9,103 |
8,975 |
$153K |
| D0330 |
Panoramic radiographic image |
1,937 |
1,918 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
3,486 |
3,433 |
$53K |
| D2394 |
|
618 |
444 |
$46K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
113 |
107 |
$42K |
| D2335 |
|
448 |
286 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
8,066 |
7,918 |
$34K |
| D2332 |
|
435 |
236 |
$30K |
| D2950 |
|
350 |
298 |
$26K |
| D2331 |
|
419 |
259 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,694 |
1,672 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
397 |
270 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,473 |
1,921 |
$18K |
| D1120 |
Prophylaxis - child |
636 |
630 |
$12K |
| D0350 |
|
700 |
162 |
$6K |
| D1206 |
Topical application of fluoride varnish |
398 |
397 |
$5K |
| D2330 |
|
41 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
272 |
271 |
$2K |
| D1351 |
Sealant - per tooth |
53 |
17 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
12 |
$1K |
| D0270 |
|
66 |
64 |
$265.20 |