| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,411 |
3,467 |
$168K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,839 |
2,717 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
6,836 |
6,707 |
$109K |
| D1110 |
Prophylaxis - adult |
7,085 |
6,960 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
6,359 |
5,996 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,706 |
1,964 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
3,735 |
3,656 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,864 |
4,794 |
$66K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
221 |
177 |
$49K |
| D1120 |
Prophylaxis - child |
2,617 |
2,583 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
891 |
761 |
$30K |
| D2331 |
|
678 |
498 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
7,971 |
7,604 |
$24K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,078 |
899 |
$24K |
| D0274 |
Bitewings - four radiographic images |
3,298 |
3,237 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,458 |
3,541 |
$12K |
| D1206 |
Topical application of fluoride varnish |
1,573 |
1,557 |
$10K |
| D9310 |
|
1,252 |
1,193 |
$10K |
| D2330 |
|
294 |
195 |
$9K |
| D0330 |
Panoramic radiographic image |
555 |
549 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
179 |
117 |
$5K |
| D2954 |
|
121 |
104 |
$5K |
| D0270 |
|
1,609 |
1,561 |
$4K |
| D2332 |
|
93 |
81 |
$4K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
14 |
$3K |
| D3320 |
|
13 |
12 |
$3K |
| D2335 |
|
48 |
26 |
$3K |
| D0272 |
Bitewings - two radiographic images |
425 |
422 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
104 |
101 |
$790.00 |
| D2950 |
|
14 |
12 |
$350.00 |
| D9110 |
|
29 |
29 |
$290.00 |
| D2940 |
|
25 |
24 |
$120.00 |
| D1999 |
|
419 |
395 |
$0.00 |