| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,256 |
288 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,190 |
683 |
$76K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
797 |
493 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,194 |
989 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
987 |
549 |
$58K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
95 |
91 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,502 |
1,477 |
$46K |
| D1110 |
Prophylaxis - adult |
1,039 |
1,025 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,188 |
1,120 |
$30K |
| D0330 |
Panoramic radiographic image |
613 |
606 |
$29K |
| D2394 |
|
291 |
222 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
230 |
85 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
660 |
656 |
$14K |
| D1206 |
Topical application of fluoride varnish |
706 |
698 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,221 |
889 |
$13K |
| D0274 |
Bitewings - four radiographic images |
513 |
505 |
$12K |
| D0350 |
|
551 |
538 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,387 |
1,312 |
$9K |
| D1120 |
Prophylaxis - child |
327 |
323 |
$8K |
| D0250 |
|
690 |
679 |
$8K |
| D2335 |
|
36 |
25 |
$5K |
| D2331 |
|
33 |
17 |
$4K |
| D4342 |
|
52 |
15 |
$3K |
| D7311 |
|
45 |
26 |
$3K |
| D2330 |
|
16 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
65 |
16 |
$1K |
| D0240 |
|
24 |
12 |
$288.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$120.00 |