| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
7,986 |
2,579 |
$513K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,270 |
3,065 |
$382K |
| D0210 |
Intraoral - complete series of radiographic images |
5,555 |
5,228 |
$380K |
| D2740 |
Crown - porcelain/ceramic |
404 |
170 |
$305K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,657 |
2,069 |
$273K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,251 |
7,852 |
$234K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,732 |
1,532 |
$164K |
| D1110 |
Prophylaxis - adult |
4,199 |
3,990 |
$149K |
| D4342 |
|
1,242 |
322 |
$127K |
| D0274 |
Bitewings - four radiographic images |
5,702 |
5,467 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
5,942 |
5,753 |
$114K |
| D2394 |
|
1,240 |
835 |
$110K |
| D2335 |
|
1,026 |
533 |
$109K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
186 |
174 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,497 |
7,277 |
$82K |
| D1120 |
Prophylaxis - child |
3,274 |
3,180 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,996 |
3,864 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
8,530 |
8,089 |
$48K |
| D2950 |
|
343 |
238 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
927 |
407 |
$46K |
| D7230 |
|
253 |
137 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
783 |
742 |
$18K |
| D0330 |
Panoramic radiographic image |
403 |
370 |
$16K |
| D4341 |
|
118 |
32 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,371 |
1,330 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
239 |
121 |
$13K |
| D0240 |
|
845 |
507 |
$11K |
| D2332 |
|
103 |
63 |
$9K |
| D2160 |
|
136 |
77 |
$9K |
| D5213 |
|
15 |
14 |
$8K |
| D4910 |
|
90 |
88 |
$5K |
| D3320 |
|
15 |
12 |
$4K |
| D1351 |
Sealant - per tooth |
180 |
42 |
$3K |
| D2140 |
|
86 |
43 |
$3K |
| D2331 |
|
33 |
25 |
$3K |
| D7220 |
|
18 |
13 |
$2K |
| D2161 |
|
16 |
13 |
$1K |
| D0270 |
|
24 |
22 |
$90.00 |