| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
9,850 |
3,217 |
$563K |
| D1110 |
Prophylaxis - adult |
10,452 |
10,007 |
$371K |
| D0330 |
Panoramic radiographic image |
7,041 |
6,688 |
$336K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,290 |
1,891 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
9,359 |
9,004 |
$166K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,760 |
1,669 |
$161K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,049 |
4,782 |
$138K |
| D5110 |
|
300 |
280 |
$110K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,469 |
917 |
$107K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
170 |
149 |
$76K |
| D5120 |
|
152 |
146 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,648 |
2,556 |
$51K |
| D2335 |
|
490 |
306 |
$47K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
811 |
544 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,647 |
2,538 |
$40K |
| D5214 |
|
71 |
67 |
$37K |
| D2140 |
|
835 |
368 |
$32K |
| D5213 |
|
53 |
53 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,639 |
2,545 |
$27K |
| D2740 |
Crown - porcelain/ceramic |
23 |
13 |
$19K |
| D2394 |
|
214 |
142 |
$17K |
| D1120 |
Prophylaxis - child |
811 |
773 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,424 |
2,283 |
$12K |
| D1351 |
Sealant - per tooth |
308 |
53 |
$7K |
| D2332 |
|
84 |
38 |
$6K |
| D3320 |
|
13 |
12 |
$4K |
| D2331 |
|
38 |
25 |
$3K |
| D2330 |
|
47 |
26 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
91 |
$2K |
| D1320 |
|
115 |
105 |
$2K |
| D2160 |
|
18 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
134 |
89 |
$635.00 |
| D0240 |
|
41 |
17 |
$408.00 |
| D1999 |
|
482 |
385 |
$0.00 |