| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
19,013 |
5,475 |
$1.15M |
| D2394 |
|
6,595 |
3,299 |
$490K |
| D1110 |
Prophylaxis - adult |
11,981 |
10,858 |
$430K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,986 |
2,705 |
$347K |
| D0330 |
Panoramic radiographic image |
7,944 |
7,003 |
$340K |
| D0274 |
Bitewings - four radiographic images |
15,289 |
13,808 |
$302K |
| D0120 |
Periodic oral evaluation - established patient |
16,277 |
14,972 |
$294K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,763 |
2,142 |
$234K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,187 |
7,490 |
$221K |
| D0210 |
Intraoral - complete series of radiographic images |
3,341 |
3,218 |
$182K |
| D2335 |
|
1,979 |
859 |
$179K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,177 |
621 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,715 |
4,414 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
11,749 |
10,665 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
2,702 |
2,460 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,731 |
6,384 |
$54K |
| D1351 |
Sealant - per tooth |
2,037 |
407 |
$53K |
| D1120 |
Prophylaxis - child |
2,507 |
2,354 |
$52K |
| D2332 |
|
684 |
353 |
$49K |
| D5110 |
|
133 |
100 |
$49K |
| D2950 |
|
369 |
232 |
$46K |
| D3320 |
|
116 |
103 |
$37K |
| D2740 |
Crown - porcelain/ceramic |
42 |
27 |
$33K |
| D4341 |
|
215 |
51 |
$23K |
| D4342 |
|
177 |
44 |
$23K |
| D1206 |
Topical application of fluoride varnish |
844 |
755 |
$21K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
36 |
24 |
$19K |
| D7230 |
|
118 |
65 |
$18K |
| D7220 |
|
140 |
94 |
$13K |
| D2752 |
|
24 |
13 |
$10K |
| D3310 |
|
44 |
21 |
$10K |
| D7310 |
|
98 |
43 |
$10K |
| D0272 |
Bitewings - two radiographic images |
877 |
793 |
$9K |
| D5213 |
|
12 |
12 |
$6K |
| D7240 |
Removal of impacted tooth - completely bony |
27 |
13 |
$5K |
| D2160 |
|
77 |
46 |
$5K |
| D5120 |
|
20 |
12 |
$5K |
| D1320 |
|
216 |
209 |
$4K |
| D2330 |
|
45 |
28 |
$3K |
| D9944 |
|
15 |
15 |
$3K |
| D2161 |
|
32 |
27 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
15 |
$1K |