| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
15,557 |
4,895 |
$888K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,096 |
7,907 |
$843K |
| D4342 |
|
7,342 |
1,846 |
$658K |
| D1110 |
Prophylaxis - adult |
17,189 |
16,270 |
$638K |
| D0330 |
Panoramic radiographic image |
8,577 |
8,131 |
$443K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,461 |
3,623 |
$368K |
| D0120 |
Periodic oral evaluation - established patient |
17,928 |
17,122 |
$351K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,742 |
4,160 |
$348K |
| D1351 |
Sealant - per tooth |
12,640 |
3,014 |
$336K |
| D0274 |
Bitewings - four radiographic images |
14,162 |
13,447 |
$316K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,554 |
8,082 |
$242K |
| D0210 |
Intraoral - complete series of radiographic images |
3,422 |
3,169 |
$184K |
| D0140 |
Limited oral evaluation - problem focused |
7,487 |
6,718 |
$167K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,664 |
9,202 |
$150K |
| D1120 |
Prophylaxis - child |
5,956 |
5,690 |
$135K |
| D1206 |
Topical application of fluoride varnish |
2,763 |
2,666 |
$68K |
| D2332 |
|
536 |
353 |
$50K |
| D2335 |
|
378 |
235 |
$36K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
602 |
358 |
$32K |
| D2740 |
Crown - porcelain/ceramic |
46 |
26 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,975 |
1,891 |
$22K |
| D2330 |
|
375 |
243 |
$22K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
27 |
$18K |
| D2331 |
|
234 |
176 |
$14K |
| D2160 |
|
204 |
152 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,739 |
2,425 |
$13K |
| D2140 |
|
327 |
225 |
$13K |
| D2394 |
|
161 |
122 |
$12K |
| D3320 |
|
12 |
12 |
$7K |
| D9944 |
|
14 |
14 |
$2K |
| D1320 |
|
28 |
27 |
$420.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
50 |
31 |
$260.00 |