| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
10,436 |
2,735 |
$657K |
| D0330 |
Panoramic radiographic image |
6,150 |
6,087 |
$265K |
| D5110 |
|
347 |
342 |
$216K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,957 |
5,899 |
$170K |
| D5120 |
|
255 |
252 |
$151K |
| D0274 |
Bitewings - four radiographic images |
5,888 |
5,826 |
$132K |
| D5226 |
|
139 |
137 |
$120K |
| D5212 |
|
201 |
201 |
$116K |
| D1110 |
Prophylaxis - adult |
2,793 |
2,757 |
$116K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,116 |
1,363 |
$115K |
| D5211 |
|
166 |
165 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,059 |
1,255 |
$88K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
208 |
186 |
$81K |
| D5225 |
|
90 |
89 |
$67K |
| D4341 |
|
918 |
411 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,190 |
2,167 |
$50K |
| D5130 |
|
95 |
94 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
493 |
346 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
6,744 |
6,666 |
$38K |
| D2740 |
Crown - porcelain/ceramic |
70 |
46 |
$35K |
| D7310 |
|
234 |
103 |
$30K |
| D1120 |
Prophylaxis - child |
661 |
655 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
445 |
336 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,653 |
6,384 |
$26K |
| D5140 |
|
50 |
50 |
$26K |
| D3320 |
|
70 |
61 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,377 |
1,351 |
$20K |
| D1351 |
Sealant - per tooth |
838 |
171 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
1,688 |
753 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
332 |
327 |
$12K |
| D2335 |
|
145 |
105 |
$10K |
| D2394 |
|
147 |
120 |
$10K |
| D2332 |
|
155 |
100 |
$9K |
| D2331 |
|
175 |
120 |
$9K |
| D2330 |
|
176 |
101 |
$7K |
| D3310 |
|
16 |
12 |
$4K |
| D0272 |
Bitewings - two radiographic images |
138 |
137 |
$2K |
| D9986 |
|
122 |
95 |
$90.00 |