| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
8,851 |
3,203 |
$542K |
| D1110 |
Prophylaxis - adult |
12,112 |
11,739 |
$434K |
| D0330 |
Panoramic radiographic image |
7,712 |
7,441 |
$370K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,452 |
3,284 |
$332K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,013 |
3,689 |
$329K |
| D2331 |
|
4,375 |
1,767 |
$275K |
| D0120 |
Periodic oral evaluation - established patient |
12,271 |
11,944 |
$218K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,714 |
2,146 |
$180K |
| D2332 |
|
2,343 |
1,242 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,872 |
5,640 |
$163K |
| D2335 |
|
1,951 |
1,043 |
$157K |
| D1351 |
Sealant - per tooth |
6,173 |
1,527 |
$141K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,528 |
5,373 |
$88K |
| D2394 |
|
1,054 |
881 |
$84K |
| D5214 |
|
160 |
154 |
$81K |
| D0274 |
Bitewings - four radiographic images |
3,219 |
3,141 |
$77K |
| D1120 |
Prophylaxis - child |
3,741 |
3,641 |
$76K |
| D2330 |
|
1,504 |
831 |
$67K |
| D5110 |
|
179 |
167 |
$66K |
| D0272 |
Bitewings - two radiographic images |
5,524 |
5,352 |
$53K |
| D5213 |
|
90 |
84 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,931 |
1,768 |
$43K |
| D9944 |
|
163 |
162 |
$38K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
85 |
79 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
4,628 |
4,146 |
$23K |
| D5120 |
|
49 |
42 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
251 |
146 |
$14K |
| D2140 |
|
271 |
130 |
$11K |
| D3320 |
|
35 |
27 |
$9K |
| D2160 |
|
84 |
71 |
$5K |
| D3310 |
|
15 |
13 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
480 |
320 |
$2K |
| D2161 |
|
19 |
16 |
$1K |