| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,724 |
1,554 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,261 |
1,530 |
$134K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,777 |
1,344 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
4,887 |
4,330 |
$91K |
| D1120 |
Prophylaxis - child |
3,494 |
3,229 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
6,068 |
5,580 |
$84K |
| D0330 |
Panoramic radiographic image |
3,294 |
2,946 |
$64K |
| D1110 |
Prophylaxis - adult |
3,102 |
2,826 |
$58K |
| D0274 |
Bitewings - four radiographic images |
3,370 |
3,050 |
$47K |
| D2740 |
Crown - porcelain/ceramic |
321 |
213 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
5,754 |
5,046 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,047 |
3,689 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,217 |
1,125 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,612 |
1,481 |
$18K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
65 |
54 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,058 |
1,361 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
934 |
762 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
130 |
93 |
$5K |
| D2750 |
|
17 |
12 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
121 |
109 |
$4K |
| D2954 |
|
111 |
61 |
$3K |
| D0272 |
Bitewings - two radiographic images |
103 |
99 |
$1K |
| D2331 |
|
33 |
24 |
$783.24 |
| D1351 |
Sealant - per tooth |
52 |
16 |
$556.24 |
| D2950 |
|
17 |
13 |
$241.74 |
| D1999 |
|
2,714 |
2,192 |
$8.80 |