| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
11,197 |
3,950 |
$673K |
| D7240 |
Removal of impacted tooth - completely bony |
1,355 |
653 |
$269K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,744 |
1,912 |
$244K |
| D7230 |
|
1,334 |
712 |
$212K |
| D0330 |
Panoramic radiographic image |
3,161 |
2,996 |
$164K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,654 |
1,077 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,387 |
800 |
$89K |
| D2740 |
Crown - porcelain/ceramic |
106 |
72 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,771 |
2,647 |
$83K |
| D0274 |
Bitewings - four radiographic images |
3,282 |
3,162 |
$78K |
| D1110 |
Prophylaxis - adult |
1,828 |
1,797 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
3,503 |
3,407 |
$68K |
| D4342 |
|
657 |
190 |
$48K |
| D7220 |
|
407 |
259 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,673 |
1,576 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
4,348 |
4,030 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,515 |
1,496 |
$26K |
| D0180 |
|
658 |
605 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
384 |
190 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,235 |
2,182 |
$20K |
| D1120 |
Prophylaxis - child |
751 |
735 |
$17K |
| D2335 |
|
108 |
53 |
$11K |
| D2160 |
|
143 |
101 |
$10K |
| D2394 |
|
96 |
67 |
$8K |
| D1351 |
Sealant - per tooth |
266 |
61 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
13 |
$6K |
| D2950 |
|
66 |
54 |
$6K |
| D2140 |
|
130 |
72 |
$6K |
| D4341 |
|
50 |
14 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
75 |
70 |
$4K |
| D7310 |
|
31 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
129 |
123 |
$1K |
| D2332 |
|
13 |
12 |
$1K |
| D1320 |
|
33 |
33 |
$546.60 |