| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,646 |
1,181 |
$351K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,119 |
1,644 |
$273K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,437 |
1,356 |
$248K |
| D0210 |
Intraoral - complete series of radiographic images |
2,313 |
1,989 |
$176K |
| D1110 |
Prophylaxis - adult |
3,956 |
3,552 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
5,619 |
5,018 |
$134K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,677 |
914 |
$129K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,360 |
585 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,076 |
2,736 |
$118K |
| D0274 |
Bitewings - four radiographic images |
3,952 |
3,540 |
$111K |
| D2332 |
|
948 |
567 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,988 |
3,007 |
$77K |
| D1120 |
Prophylaxis - child |
2,549 |
2,269 |
$75K |
| D1351 |
Sealant - per tooth |
1,475 |
333 |
$60K |
| D1206 |
Topical application of fluoride varnish |
2,714 |
2,444 |
$55K |
| D2394 |
|
366 |
289 |
$47K |
| D2740 |
Crown - porcelain/ceramic |
60 |
25 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
4,380 |
3,883 |
$40K |
| D2335 |
|
163 |
97 |
$24K |
| D3310 |
|
70 |
37 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
660 |
576 |
$23K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
32 |
29 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,054 |
916 |
$17K |
| D0330 |
Panoramic radiographic image |
179 |
155 |
$13K |
| D2331 |
|
107 |
45 |
$7K |
| D0350 |
|
396 |
350 |
$7K |
| D2330 |
|
23 |
12 |
$1K |
| D1320 |
|
27 |
26 |
$955.14 |
| D0272 |
Bitewings - two radiographic images |
67 |
65 |
$949.37 |