| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,112 |
1,320 |
$146K |
| D1110 |
Prophylaxis - adult |
3,005 |
2,911 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,666 |
892 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,489 |
978 |
$74K |
| D0330 |
Panoramic radiographic image |
1,707 |
1,657 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
951 |
649 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,198 |
2,144 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,741 |
2,657 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,819 |
1,766 |
$33K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
75 |
71 |
$27K |
| D1120 |
Prophylaxis - child |
1,203 |
1,181 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,499 |
1,466 |
$22K |
| D2332 |
|
382 |
235 |
$18K |
| D2931 |
|
163 |
146 |
$17K |
| D2330 |
|
320 |
178 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
435 |
426 |
$9K |
| D3320 |
|
25 |
24 |
$7K |
| D2331 |
|
135 |
89 |
$7K |
| D0604 |
|
159 |
78 |
$6K |
| D0272 |
Bitewings - two radiographic images |
508 |
494 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
850 |
822 |
$4K |
| D2335 |
|
47 |
13 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
256 |
250 |
$1K |