| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,099 |
1,263 |
$199K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,970 |
1,512 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,458 |
5,249 |
$152K |
| D1110 |
Prophylaxis - adult |
3,055 |
2,930 |
$113K |
| D0330 |
Panoramic radiographic image |
2,351 |
2,211 |
$110K |
| D0210 |
Intraoral - complete series of radiographic images |
1,436 |
1,381 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,271 |
753 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
942 |
633 |
$63K |
| D0274 |
Bitewings - four radiographic images |
3,023 |
2,842 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,568 |
2,488 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,072 |
3,001 |
$49K |
| D1120 |
Prophylaxis - child |
2,289 |
2,253 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,375 |
3,667 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
4,475 |
4,212 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
390 |
165 |
$22K |
| D0340 |
|
172 |
170 |
$20K |
| D1351 |
Sealant - per tooth |
907 |
219 |
$20K |
| D2394 |
|
253 |
184 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
657 |
641 |
$15K |
| D7230 |
|
92 |
60 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,280 |
1,268 |
$14K |
| D8670 |
Periodic orthodontic treatment visit |
16 |
16 |
$8K |
| D0470 |
|
172 |
170 |
$7K |
| D0240 |
|
595 |
380 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
115 |
73 |
$6K |
| D2950 |
|
36 |
32 |
$5K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$5K |
| D4342 |
|
36 |
12 |
$5K |
| D2330 |
|
81 |
44 |
$4K |
| D0350 |
|
172 |
169 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
39 |
29 |
$4K |
| D2140 |
|
81 |
55 |
$3K |
| D2160 |
|
45 |
29 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
15 |
$1K |
| D1354 |
|
73 |
24 |
$1K |
| D1320 |
|
33 |
28 |
$450.00 |