| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
14,404 |
1,762 |
$963K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,062 |
1,004 |
$445K |
| D5110 |
|
562 |
551 |
$374K |
| D5130 |
|
471 |
458 |
$320K |
| D5120 |
|
401 |
394 |
$274K |
| D5140 |
|
278 |
270 |
$186K |
| D0330 |
Panoramic radiographic image |
3,157 |
3,028 |
$119K |
| D1110 |
Prophylaxis - adult |
2,032 |
1,917 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,707 |
2,596 |
$77K |
| D2740 |
Crown - porcelain/ceramic |
85 |
42 |
$41K |
| D5750 |
|
230 |
222 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,886 |
1,783 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,339 |
1,287 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
461 |
301 |
$31K |
| D5211 |
|
44 |
44 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
364 |
223 |
$23K |
| D5212 |
|
43 |
43 |
$23K |
| D5751 |
|
90 |
88 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
587 |
571 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
559 |
522 |
$12K |
| D7310 |
|
117 |
59 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
427 |
414 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
65 |
39 |
$5K |
| D0272 |
Bitewings - two radiographic images |
282 |
256 |
$4K |
| D2330 |
|
45 |
29 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
95 |
90 |
$2K |
| D1206 |
Topical application of fluoride varnish |
79 |
78 |
$1K |
| D2331 |
|
16 |
13 |
$959.16 |
| D0230 |
Intraoral - periapical each additional radiographic image |
119 |
93 |
$905.65 |