| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,251 |
1,319 |
$188K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,713 |
1,015 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,351 |
934 |
$74K |
| D1110 |
Prophylaxis - adult |
1,959 |
1,958 |
$68K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
154 |
153 |
$60K |
| D0330 |
Panoramic radiographic image |
1,069 |
1,065 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,785 |
1,783 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,685 |
1,679 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,776 |
1,775 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
630 |
572 |
$31K |
| D1120 |
Prophylaxis - child |
1,343 |
1,343 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
314 |
269 |
$20K |
| D2950 |
|
245 |
212 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
845 |
838 |
$19K |
| D2330 |
|
287 |
206 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
935 |
935 |
$14K |
| D3320 |
|
46 |
42 |
$14K |
| D2335 |
|
128 |
89 |
$12K |
| D1206 |
Topical application of fluoride varnish |
704 |
704 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,772 |
1,717 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
82 |
53 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,451 |
1,176 |
$7K |
| D2331 |
|
89 |
73 |
$6K |
| D0272 |
Bitewings - two radiographic images |
603 |
601 |
$6K |
| D1351 |
Sealant - per tooth |
233 |
72 |
$5K |
| D2332 |
|
51 |
43 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
31 |
$3K |
| D3310 |
|
12 |
12 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
14 |
$984.81 |
| D0270 |
|
27 |
26 |
$105.00 |