| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,734 |
1,924 |
$526K |
| D8670 |
Periodic orthodontic treatment visit |
1,241 |
1,220 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,777 |
3,664 |
$152K |
| D0340 |
|
2,508 |
2,423 |
$142K |
| D0330 |
Panoramic radiographic image |
2,595 |
2,527 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
959 |
734 |
$118K |
| D0140 |
Limited oral evaluation - problem focused |
3,152 |
3,052 |
$111K |
| D0350 |
|
2,886 |
2,801 |
$89K |
| D1110 |
Prophylaxis - adult |
1,759 |
1,690 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
825 |
538 |
$79K |
| D4910 |
|
929 |
916 |
$60K |
| D8090 |
|
24 |
24 |
$60K |
| D8680 |
|
231 |
231 |
$55K |
| D4342 |
|
528 |
278 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
250 |
145 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
650 |
599 |
$31K |
| D0470 |
|
656 |
627 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,016 |
1,951 |
$25K |
| D0180 |
|
751 |
726 |
$22K |
| D0160 |
|
281 |
252 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
785 |
743 |
$19K |
| D9420 |
|
157 |
136 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
444 |
431 |
$17K |
| D2330 |
|
112 |
78 |
$11K |
| D2950 |
|
63 |
52 |
$8K |
| D2331 |
|
70 |
53 |
$8K |
| D5110 |
|
13 |
13 |
$7K |
| D2740 |
Crown - porcelain/ceramic |
13 |
12 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
37 |
$6K |
| D0274 |
Bitewings - four radiographic images |
263 |
251 |
$6K |
| D1206 |
Topical application of fluoride varnish |
698 |
616 |
$4K |
| D4341 |
|
19 |
12 |
$2K |
| D1354 |
|
18 |
12 |
$198.00 |