| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,961 |
1,940 |
$402K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,066 |
1,769 |
$329K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,203 |
1,573 |
$320K |
| D2335 |
|
2,793 |
856 |
$263K |
| D0330 |
Panoramic radiographic image |
3,010 |
2,934 |
$140K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,844 |
765 |
$116K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,097 |
175 |
$112K |
| D2330 |
|
2,033 |
691 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,568 |
3,471 |
$95K |
| D1110 |
Prophylaxis - adult |
2,465 |
2,427 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
4,325 |
4,289 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,718 |
4,639 |
$71K |
| D1120 |
Prophylaxis - child |
3,476 |
3,440 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
2,223 |
2,196 |
$51K |
| D5214 |
|
84 |
83 |
$45K |
| D2140 |
|
837 |
223 |
$33K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
601 |
215 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,492 |
1,474 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
509 |
502 |
$29K |
| D2332 |
|
333 |
143 |
$25K |
| D2160 |
|
334 |
137 |
$22K |
| D5213 |
|
41 |
40 |
$21K |
| D2740 |
Crown - porcelain/ceramic |
68 |
43 |
$21K |
| D1351 |
Sealant - per tooth |
841 |
218 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
179 |
65 |
$11K |
| D5110 |
|
31 |
26 |
$11K |
| D0272 |
Bitewings - two radiographic images |
902 |
899 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
153 |
64 |
$9K |
| D2394 |
|
62 |
19 |
$3K |
| D2950 |
|
21 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$120.00 |