| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
7,928 |
1,827 |
$467K |
| D2740 |
Crown - porcelain/ceramic |
292 |
150 |
$238K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,833 |
2,113 |
$208K |
| D1110 |
Prophylaxis - adult |
4,029 |
3,845 |
$147K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,722 |
1,641 |
$144K |
| D0330 |
Panoramic radiographic image |
2,705 |
2,589 |
$123K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
222 |
202 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
6,253 |
5,979 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,379 |
3,238 |
$100K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,277 |
887 |
$81K |
| D9243 |
|
1,903 |
847 |
$70K |
| D0274 |
Bitewings - four radiographic images |
3,479 |
3,305 |
$59K |
| D9239 |
|
807 |
719 |
$57K |
| D2335 |
|
595 |
328 |
$51K |
| D1120 |
Prophylaxis - child |
2,467 |
2,385 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,475 |
2,390 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
5,106 |
4,708 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,192 |
3,689 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,197 |
1,144 |
$23K |
| D2950 |
|
131 |
115 |
$19K |
| D2331 |
|
294 |
200 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
686 |
644 |
$15K |
| D2332 |
|
147 |
99 |
$10K |
| D3320 |
|
17 |
13 |
$10K |
| D2394 |
|
120 |
80 |
$9K |
| D2330 |
|
185 |
121 |
$9K |
| D0272 |
Bitewings - two radiographic images |
971 |
938 |
$8K |
| D7230 |
|
44 |
13 |
$7K |
| D2931 |
|
51 |
37 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
280 |
169 |
$5K |
| D5110 |
|
12 |
12 |
$4K |
| D1351 |
Sealant - per tooth |
142 |
36 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
13 |
$1K |
| D1320 |
|
31 |
28 |
$465.00 |
| D0240 |
|
28 |
28 |
$321.00 |