| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
7,325 |
3,145 |
$730K |
| D2750 |
|
835 |
621 |
$472K |
| D2740 |
Crown - porcelain/ceramic |
399 |
179 |
$338K |
| D0210 |
Intraoral - complete series of radiographic images |
3,489 |
3,479 |
$278K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,995 |
5,979 |
$239K |
| D4342 |
|
2,168 |
733 |
$235K |
| D2950 |
|
1,618 |
1,207 |
$210K |
| D1110 |
Prophylaxis - adult |
3,833 |
3,819 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
890 |
547 |
$120K |
| D0140 |
Limited oral evaluation - problem focused |
3,158 |
3,141 |
$108K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
962 |
472 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
3,678 |
3,665 |
$88K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,042 |
2,039 |
$87K |
| D2752 |
|
160 |
100 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
5,241 |
5,204 |
$65K |
| D4341 |
|
254 |
109 |
$55K |
| D0274 |
Bitewings - four radiographic images |
979 |
974 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
172 |
103 |
$27K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
25 |
25 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
157 |
97 |
$16K |
| D2791 |
|
30 |
26 |
$14K |
| D3320 |
|
15 |
13 |
$13K |
| D2160 |
|
106 |
71 |
$13K |
| D2332 |
|
68 |
36 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
56 |
37 |
$9K |
| D4910 |
|
65 |
65 |
$6K |
| D2140 |
|
71 |
46 |
$6K |
| D2331 |
|
22 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
43 |
43 |
$705.06 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$390.78 |