| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,810 |
986 |
$203K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,922 |
1,434 |
$195K |
| D0210 |
Intraoral - complete series of radiographic images |
2,514 |
2,436 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,614 |
3,528 |
$114K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,338 |
812 |
$108K |
| D1110 |
Prophylaxis - adult |
2,014 |
1,976 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,441 |
798 |
$83K |
| D2740 |
Crown - porcelain/ceramic |
100 |
64 |
$77K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
92 |
85 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,456 |
1,418 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,622 |
1,591 |
$38K |
| D1120 |
Prophylaxis - child |
1,359 |
1,347 |
$32K |
| D2950 |
|
227 |
170 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,621 |
1,598 |
$30K |
| D0330 |
Panoramic radiographic image |
403 |
391 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,510 |
1,612 |
$21K |
| D1351 |
Sealant - per tooth |
888 |
226 |
$19K |
| D2335 |
|
120 |
66 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,125 |
2,061 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
315 |
308 |
$11K |
| D4342 |
|
103 |
29 |
$9K |
| D2394 |
|
74 |
49 |
$6K |
| D2331 |
|
41 |
24 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
40 |
13 |
$2K |
| D2332 |
|
17 |
15 |
$1K |
| D1320 |
|
68 |
66 |
$975.00 |