| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
5,635 |
5,410 |
$248K |
| D8030 |
|
2,855 |
2,696 |
$236K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,194 |
1,221 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,185 |
1,569 |
$165K |
| D1110 |
Prophylaxis - adult |
4,078 |
3,917 |
$133K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,435 |
1,150 |
$119K |
| D0140 |
Limited oral evaluation - problem focused |
5,450 |
5,067 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,332 |
3,205 |
$85K |
| D2335 |
|
955 |
419 |
$84K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,180 |
706 |
$73K |
| D8680 |
|
384 |
179 |
$67K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,268 |
613 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
3,949 |
3,792 |
$64K |
| D2160 |
|
726 |
354 |
$45K |
| D2332 |
|
676 |
333 |
$43K |
| D0274 |
Bitewings - four radiographic images |
2,244 |
2,149 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,131 |
2,047 |
$31K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
80 |
66 |
$28K |
| D8670 |
Periodic orthodontic treatment visit |
149 |
133 |
$26K |
| D5110 |
|
77 |
67 |
$24K |
| D1120 |
Prophylaxis - child |
1,156 |
1,118 |
$22K |
| D2331 |
|
506 |
268 |
$20K |
| D2140 |
|
466 |
255 |
$18K |
| D2330 |
|
451 |
189 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
3,158 |
2,937 |
$15K |
| D4341 |
|
150 |
64 |
$12K |
| D5214 |
|
26 |
16 |
$10K |
| D2752 |
|
29 |
14 |
$10K |
| D3320 |
|
32 |
27 |
$10K |
| D2394 |
|
127 |
100 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,789 |
643 |
$8K |
| D0340 |
|
118 |
108 |
$7K |
| D5120 |
|
18 |
15 |
$6K |
| D0272 |
Bitewings - two radiographic images |
637 |
599 |
$6K |
| D1351 |
Sealant - per tooth |
191 |
54 |
$4K |
| D0470 |
|
123 |
113 |
$3K |
| D2161 |
|
32 |
25 |
$2K |
| D0350 |
|
128 |
118 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
15 |
$1K |