| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,546 |
707 |
$121K |
| D1110 |
Prophylaxis - adult |
2,122 |
2,083 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
994 |
589 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,415 |
2,350 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
803 |
776 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,223 |
2,181 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
506 |
366 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,988 |
1,966 |
$43K |
| D0330 |
Panoramic radiographic image |
854 |
829 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
454 |
253 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,629 |
2,894 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,160 |
1,148 |
$24K |
| D1120 |
Prophylaxis - child |
766 |
757 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
3,210 |
3,132 |
$20K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
26 |
$20K |
| D2394 |
|
108 |
87 |
$10K |
| D2950 |
|
53 |
50 |
$8K |
| D0272 |
Bitewings - two radiographic images |
343 |
339 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
144 |
$5K |
| D2335 |
|
25 |
14 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
13 |
$2K |
| D2331 |
|
29 |
15 |
$1K |
| D1320 |
|
88 |
87 |
$1K |