| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
9,406 |
2,130 |
$578K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,585 |
1,327 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,679 |
971 |
$79K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
165 |
85 |
$75K |
| D1110 |
Prophylaxis - adult |
2,680 |
2,666 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
4,232 |
4,191 |
$67K |
| D0330 |
Panoramic radiographic image |
1,741 |
1,731 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
797 |
485 |
$50K |
| D5130 |
|
100 |
99 |
$48K |
| D9110 |
|
1,298 |
1,289 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,143 |
1,133 |
$29K |
| D2332 |
|
438 |
262 |
$27K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
51 |
45 |
$25K |
| D2330 |
|
524 |
284 |
$23K |
| D2335 |
|
382 |
191 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,217 |
1,211 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,858 |
1,422 |
$20K |
| D9920 |
|
160 |
158 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,810 |
2,724 |
$18K |
| D2331 |
|
343 |
240 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
251 |
248 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
160 |
160 |
$8K |
| D1120 |
Prophylaxis - child |
283 |
283 |
$8K |
| D7310 |
|
282 |
115 |
$8K |
| D5140 |
|
15 |
15 |
$7K |
| D1206 |
Topical application of fluoride varnish |
264 |
261 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
86 |
86 |
$2K |
| D2394 |
|
23 |
17 |
$1K |
| D0272 |
Bitewings - two radiographic images |
73 |
70 |
$1K |