| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,681 |
1,069 |
$160K |
| D1110 |
Prophylaxis - adult |
4,360 |
3,467 |
$145K |
| D0330 |
Panoramic radiographic image |
1,654 |
1,257 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
3,737 |
2,819 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,311 |
2,021 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,286 |
1,756 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
724 |
693 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,128 |
1,608 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,697 |
1,443 |
$26K |
| D1120 |
Prophylaxis - child |
1,203 |
916 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
497 |
334 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
3,054 |
2,467 |
$13K |
| D1320 |
|
1,238 |
1,219 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
270 |
185 |
$10K |
| D2950 |
|
59 |
43 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
12 |
$6K |
| D0272 |
Bitewings - two radiographic images |
457 |
326 |
$5K |
| D2394 |
|
114 |
87 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,011 |
850 |
$3K |
| D2160 |
|
30 |
15 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
25 |
$1K |
| D2335 |
|
29 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
14 |
$972.00 |
| D2140 |
|
18 |
14 |
$680.00 |
| D0240 |
|
40 |
28 |
$72.00 |