| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,175 |
1,119 |
$313K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,812 |
1,247 |
$243K |
| D1110 |
Prophylaxis - adult |
3,585 |
3,515 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,035 |
2,975 |
$116K |
| D0140 |
Limited oral evaluation - problem focused |
2,960 |
2,874 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
946 |
622 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
4,115 |
4,054 |
$97K |
| D0330 |
Panoramic radiographic image |
1,464 |
1,433 |
$74K |
| D1120 |
Prophylaxis - child |
1,688 |
1,652 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,585 |
1,562 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,166 |
3,095 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,130 |
2,084 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
553 |
539 |
$35K |
| D2740 |
Crown - porcelain/ceramic |
65 |
49 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
710 |
700 |
$18K |
| D2750 |
|
35 |
25 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
60 |
$11K |
| D0272 |
Bitewings - two radiographic images |
428 |
424 |
$9K |
| D2950 |
|
66 |
39 |
$8K |
| D2331 |
|
66 |
39 |
$7K |
| D1351 |
Sealant - per tooth |
68 |
25 |
$2K |