| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,315 |
1,564 |
$290K |
| D1110 |
Prophylaxis - adult |
4,643 |
4,541 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,682 |
1,709 |
$140K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
365 |
328 |
$133K |
| D0210 |
Intraoral - complete series of radiographic images |
2,285 |
2,212 |
$123K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,728 |
1,138 |
$108K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,437 |
881 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,757 |
2,693 |
$71K |
| D5110 |
|
191 |
181 |
$70K |
| D2335 |
|
786 |
423 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
3,939 |
3,885 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
2,942 |
2,757 |
$63K |
| D0274 |
Bitewings - four radiographic images |
3,204 |
3,153 |
$61K |
| D2160 |
|
961 |
666 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,141 |
4,074 |
$48K |
| D2752 |
|
111 |
73 |
$46K |
| D4341 |
|
507 |
204 |
$45K |
| D2394 |
|
561 |
383 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
766 |
531 |
$37K |
| D2332 |
|
487 |
305 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
6,661 |
5,974 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,964 |
1,948 |
$28K |
| D2331 |
|
430 |
313 |
$24K |
| D5120 |
|
56 |
55 |
$21K |
| D0330 |
Panoramic radiographic image |
456 |
444 |
$20K |
| D1120 |
Prophylaxis - child |
949 |
938 |
$18K |
| D2161 |
|
140 |
111 |
$11K |
| D3320 |
|
33 |
30 |
$10K |
| D5214 |
|
12 |
12 |
$6K |
| D2931 |
|
46 |
36 |
$5K |
| D2952 |
|
35 |
24 |
$5K |
| D0272 |
Bitewings - two radiographic images |
426 |
419 |
$4K |
| D1351 |
Sealant - per tooth |
45 |
12 |
$968.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26 |
26 |
$625.00 |
| D2140 |
|
15 |
12 |
$560.00 |