| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
8,122 |
2,528 |
$694K |
| D2722 |
|
561 |
311 |
$494K |
| D0330 |
Panoramic radiographic image |
6,051 |
6,017 |
$396K |
| D5110 |
|
393 |
384 |
$373K |
| D7250 |
|
2,168 |
758 |
$335K |
| D0274 |
Bitewings - four radiographic images |
8,445 |
8,400 |
$296K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,054 |
10,906 |
$238K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,025 |
5,999 |
$215K |
| D1110 |
Prophylaxis - adult |
3,925 |
3,911 |
$196K |
| D0220 |
Intraoral - periapical first radiographic image |
12,417 |
12,172 |
$179K |
| D1206 |
Topical application of fluoride varnish |
6,841 |
6,812 |
$169K |
| D5120 |
|
168 |
166 |
$167K |
| D0120 |
Periodic oral evaluation - established patient |
5,173 |
5,156 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,600 |
935 |
$123K |
| D1120 |
Prophylaxis - child |
3,306 |
3,289 |
$117K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,417 |
846 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
2,410 |
2,341 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,011 |
661 |
$62K |
| D4355 |
|
1,174 |
1,174 |
$55K |
| D0272 |
Bitewings - two radiographic images |
1,533 |
1,524 |
$48K |
| D5214 |
|
42 |
40 |
$41K |
| D2160 |
|
421 |
306 |
$39K |
| D2331 |
|
331 |
237 |
$31K |
| D2950 |
|
187 |
157 |
$30K |
| D1330 |
|
928 |
923 |
$26K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
38 |
37 |
$22K |
| D4341 |
|
122 |
51 |
$22K |
| D2991 |
|
125 |
21 |
$16K |
| D5225 |
|
13 |
12 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
141 |
106 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
81 |
49 |
$10K |
| D2335 |
|
94 |
75 |
$10K |
| D2140 |
|
142 |
103 |
$10K |
| D1351 |
Sealant - per tooth |
227 |
67 |
$6K |
| D2332 |
|
57 |
43 |
$6K |
| D9110 |
|
57 |
55 |
$2K |
| D2330 |
|
23 |
14 |
$2K |
| D1999 |
|
135 |
130 |
$0.00 |