| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,699 |
778 |
$236K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,184 |
1,156 |
$214K |
| D0210 |
Intraoral - complete series of radiographic images |
1,781 |
1,568 |
$152K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,013 |
680 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,403 |
2,143 |
$97K |
| D1110 |
Prophylaxis - adult |
2,065 |
1,863 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
2,481 |
2,219 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
510 |
346 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,573 |
1,416 |
$44K |
| D1120 |
Prophylaxis - child |
1,089 |
981 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,505 |
1,369 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
242 |
114 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
514 |
459 |
$20K |
| D2740 |
Crown - porcelain/ceramic |
20 |
13 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,336 |
1,162 |
$13K |
| D2331 |
|
120 |
80 |
$13K |
| D2335 |
|
82 |
52 |
$12K |
| D3310 |
|
43 |
12 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$8K |
| D2394 |
|
53 |
27 |
$6K |
| D1351 |
Sealant - per tooth |
118 |
28 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
476 |
193 |
$3K |
| D2332 |
|
37 |
26 |
$3K |
| D2330 |
|
25 |
14 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
47 |
26 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
116 |
100 |
$2K |
| D2160 |
|
19 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
18 |
13 |
$318.70 |
| D0350 |
|
35 |
28 |
$294.65 |