| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
8,014 |
2,511 |
$451K |
| D2335 |
|
3,080 |
1,387 |
$273K |
| D0330 |
Panoramic radiographic image |
5,103 |
5,016 |
$208K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,772 |
7,622 |
$200K |
| D1110 |
Prophylaxis - adult |
5,762 |
5,650 |
$193K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,596 |
1,644 |
$165K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,106 |
1,580 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,649 |
1,644 |
$140K |
| D0210 |
Intraoral - complete series of radiographic images |
2,879 |
2,809 |
$139K |
| D0274 |
Bitewings - four radiographic images |
7,950 |
7,781 |
$126K |
| D0140 |
Limited oral evaluation - problem focused |
5,426 |
5,259 |
$121K |
| D2394 |
|
1,172 |
905 |
$88K |
| D2332 |
|
1,197 |
764 |
$84K |
| D2160 |
|
1,296 |
746 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
4,589 |
4,525 |
$76K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,400 |
782 |
$73K |
| D7310 |
|
674 |
398 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,383 |
2,337 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
5,733 |
5,519 |
$29K |
| D2161 |
|
359 |
277 |
$26K |
| D4342 |
|
383 |
99 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,714 |
3,243 |
$23K |
| D1351 |
Sealant - per tooth |
996 |
215 |
$21K |
| D1120 |
Prophylaxis - child |
1,110 |
1,079 |
$20K |
| D5110 |
|
45 |
42 |
$16K |
| D2140 |
|
394 |
187 |
$15K |
| D2330 |
|
344 |
187 |
$15K |
| D2331 |
|
186 |
100 |
$11K |
| D4341 |
|
95 |
28 |
$9K |
| D5214 |
|
15 |
15 |
$8K |
| D7320 |
|
66 |
25 |
$8K |
| D5213 |
|
14 |
14 |
$8K |
| D3310 |
|
17 |
12 |
$4K |
| D3320 |
|
16 |
12 |
$4K |
| D0272 |
Bitewings - two radiographic images |
339 |
331 |
$2K |
| D7220 |
|
15 |
12 |
$2K |