| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4342 |
|
3,245 |
835 |
$377K |
| D0330 |
Panoramic radiographic image |
4,713 |
4,597 |
$268K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,866 |
366 |
$182K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,791 |
4,667 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,499 |
841 |
$141K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,443 |
780 |
$120K |
| D2740 |
Crown - porcelain/ceramic |
126 |
79 |
$102K |
| D5213 |
|
95 |
93 |
$86K |
| D5110 |
|
124 |
119 |
$79K |
| D2394 |
|
735 |
468 |
$76K |
| D5214 |
|
78 |
77 |
$67K |
| D5120 |
|
93 |
91 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
731 |
454 |
$51K |
| D0350 |
|
2,592 |
1,567 |
$49K |
| D1320 |
|
1,767 |
1,727 |
$35K |
| D4341 |
|
239 |
69 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,172 |
1,129 |
$25K |
| D7310 |
|
126 |
52 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,082 |
1,022 |
$24K |
| D1110 |
Prophylaxis - adult |
631 |
607 |
$21K |
| D2335 |
|
108 |
49 |
$16K |
| D7311 |
|
173 |
101 |
$16K |
| D2950 |
|
115 |
71 |
$15K |
| D0470 |
|
366 |
354 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
31 |
25 |
$10K |
| D0274 |
Bitewings - four radiographic images |
295 |
279 |
$9K |
| D8210 |
|
30 |
30 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
835 |
662 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
832 |
465 |
$4K |
| D4910 |
|
39 |
39 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
48 |
14 |
$3K |
| D2160 |
|
28 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
93 |
92 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
67 |
67 |
$1K |
| D2332 |
|
54 |
13 |
$996.06 |
| D2140 |
|
23 |
13 |
$920.00 |
| D0180 |
|
19 |
17 |
$704.90 |