| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
17,744 |
4,363 |
$1.13M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,528 |
5,025 |
$590K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,503 |
3,432 |
$407K |
| D0210 |
Intraoral - complete series of radiographic images |
5,340 |
5,085 |
$372K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,351 |
10,817 |
$338K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,019 |
2,884 |
$292K |
| D0330 |
Panoramic radiographic image |
6,135 |
5,873 |
$283K |
| D1110 |
Prophylaxis - adult |
7,207 |
6,854 |
$279K |
| D2394 |
|
3,054 |
1,987 |
$257K |
| D2332 |
|
2,777 |
1,570 |
$248K |
| D0274 |
Bitewings - four radiographic images |
11,178 |
10,589 |
$206K |
| D2335 |
|
1,761 |
927 |
$196K |
| D0120 |
Periodic oral evaluation - established patient |
9,001 |
8,549 |
$176K |
| D2331 |
|
1,063 |
517 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,574 |
4,395 |
$72K |
| D1320 |
|
3,316 |
3,120 |
$69K |
| D1120 |
Prophylaxis - child |
2,429 |
2,349 |
$46K |
| D2330 |
|
519 |
331 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
4,695 |
4,418 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,624 |
1,304 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
303 |
153 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
640 |
611 |
$16K |
| D5110 |
|
28 |
24 |
$15K |
| D2160 |
|
179 |
114 |
$12K |
| D0272 |
Bitewings - two radiographic images |
983 |
954 |
$8K |
| D2161 |
|
93 |
60 |
$7K |
| D7310 |
|
68 |
26 |
$6K |
| D2140 |
|
120 |
72 |
$5K |
| D3310 |
|
17 |
14 |
$4K |