| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,547 |
482 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,089 |
585 |
$79K |
| D2740 |
Crown - porcelain/ceramic |
164 |
108 |
$78K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
784 |
318 |
$77K |
| D1110 |
Prophylaxis - adult |
1,271 |
1,201 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,171 |
1,108 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
509 |
307 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
334 |
214 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
749 |
716 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,048 |
999 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
1,015 |
942 |
$20K |
| D0330 |
Panoramic radiographic image |
561 |
536 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,260 |
1,134 |
$14K |
| D0274 |
Bitewings - four radiographic images |
510 |
481 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
13 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
338 |
320 |
$8K |
| D7250 |
|
48 |
16 |
$5K |
| D0270 |
|
566 |
533 |
$5K |
| D4355 |
|
65 |
59 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
505 |
459 |
$4K |
| D4341 |
|
38 |
13 |
$3K |
| D2950 |
|
156 |
99 |
$2K |
| D7311 |
|
24 |
20 |
$587.88 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
15 |
$435.10 |
| D0460 |
|
68 |
47 |
$0.00 |
| D9910 |
|
137 |
51 |
$0.00 |
| D1330 |
|
24 |
23 |
$0.00 |