| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
8,498 |
6,642 |
$281K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,713 |
3,632 |
$261K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,965 |
3,292 |
$237K |
| D1110 |
Prophylaxis - adult |
5,301 |
5,181 |
$176K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,150 |
6,689 |
$165K |
| D2740 |
Crown - porcelain/ceramic |
834 |
713 |
$163K |
| D0210 |
Intraoral - complete series of radiographic images |
4,413 |
3,815 |
$154K |
| D2950 |
|
2,108 |
1,841 |
$148K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,019 |
1,358 |
$130K |
| D2335 |
|
1,115 |
851 |
$98K |
| D2331 |
|
1,634 |
1,148 |
$90K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,359 |
1,214 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
5,372 |
4,555 |
$82K |
| D4341 |
|
1,558 |
755 |
$80K |
| D2332 |
|
1,028 |
721 |
$71K |
| D2330 |
|
1,327 |
952 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,624 |
2,564 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
6,342 |
5,198 |
$45K |
| D5110 |
|
161 |
161 |
$38K |
| D2394 |
|
396 |
359 |
$36K |
| D4910 |
|
849 |
837 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
2,470 |
2,415 |
$32K |
| D4342 |
|
907 |
493 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,410 |
1,191 |
$16K |
| D3320 |
|
51 |
48 |
$8K |
| D1206 |
Topical application of fluoride varnish |
1,007 |
961 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
77 |
48 |
$4K |
| D0270 |
|
429 |
420 |
$3K |
| D3221 |
|
54 |
54 |
$2K |
| D2940 |
|
45 |
43 |
$2K |
| D4346 |
|
89 |
89 |
$686.20 |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$282.10 |
| D0470 |
|
59 |
57 |
$39.00 |
| D0190 |
|
92 |
92 |
$0.00 |
| D0160 |
|
12 |
12 |
$0.00 |
| D5120 |
|
25 |
25 |
$0.00 |
| D5214 |
|
41 |
41 |
$0.00 |
| D3310 |
|
38 |
31 |
$0.00 |