| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
9,295 |
1,884 |
$576K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,734 |
856 |
$105K |
| D1110 |
Prophylaxis - adult |
2,092 |
2,085 |
$73K |
| D7230 |
|
401 |
187 |
$70K |
| D0330 |
Panoramic radiographic image |
1,905 |
1,902 |
$69K |
| D1351 |
Sealant - per tooth |
2,674 |
369 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,334 |
702 |
$66K |
| D5110 |
|
110 |
110 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,319 |
2,311 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
2,313 |
2,303 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,630 |
1,626 |
$44K |
| D7240 |
Removal of impacted tooth - completely bony |
174 |
64 |
$35K |
| D5120 |
|
70 |
70 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,525 |
1,520 |
$27K |
| D1120 |
Prophylaxis - child |
804 |
800 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,538 |
1,529 |
$25K |
| D1310 |
|
1,828 |
1,826 |
$21K |
| D1330 |
|
1,784 |
1,782 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
214 |
162 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
261 |
256 |
$13K |
| D2330 |
|
255 |
145 |
$12K |
| D2331 |
|
157 |
112 |
$9K |
| D5214 |
|
15 |
15 |
$9K |
| D5213 |
|
12 |
12 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
12 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
736 |
725 |
$5K |
| D9110 |
|
136 |
132 |
$4K |
| D2332 |
|
52 |
31 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
81 |
75 |
$545.44 |