| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
12,984 |
2,786 |
$884K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,257 |
1,122 |
$622K |
| D5110 |
|
959 |
944 |
$445K |
| D5120 |
|
644 |
638 |
$297K |
| D5214 |
|
366 |
361 |
$231K |
| D3320 |
|
512 |
428 |
$195K |
| D0330 |
Panoramic radiographic image |
3,438 |
3,423 |
$189K |
| D2740 |
Crown - porcelain/ceramic |
167 |
115 |
$136K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,748 |
1,184 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,542 |
3,525 |
$109K |
| D1110 |
Prophylaxis - adult |
2,576 |
2,568 |
$104K |
| D7310 |
|
724 |
323 |
$74K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
910 |
650 |
$69K |
| D5213 |
|
93 |
93 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,188 |
2,184 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
658 |
503 |
$41K |
| D2954 |
|
171 |
140 |
$35K |
| D3310 |
|
61 |
41 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,959 |
2,886 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,386 |
1,382 |
$17K |
| D0274 |
Bitewings - four radiographic images |
565 |
560 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
205 |
201 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
295 |
293 |
$7K |
| D2331 |
|
84 |
55 |
$5K |
| D1206 |
Topical application of fluoride varnish |
238 |
238 |
$4K |
| D7230 |
|
24 |
12 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
174 |
174 |
$3K |
| D1120 |
Prophylaxis - child |
131 |
131 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
263 |
202 |
$2K |