| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,786 |
1,531 |
$419K |
| D0330 |
Panoramic radiographic image |
5,879 |
5,394 |
$363K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,392 |
2,019 |
$260K |
| D1110 |
Prophylaxis - adult |
4,632 |
4,321 |
$244K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,580 |
6,003 |
$224K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,038 |
1,438 |
$191K |
| D0274 |
Bitewings - four radiographic images |
6,487 |
6,038 |
$182K |
| D2740 |
Crown - porcelain/ceramic |
269 |
182 |
$148K |
| D4341 |
|
1,800 |
680 |
$138K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,086 |
496 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,226 |
812 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,462 |
2,364 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
1,832 |
1,684 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,517 |
4,761 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
7,617 |
6,874 |
$63K |
| D2394 |
|
527 |
418 |
$55K |
| D4342 |
|
465 |
183 |
$38K |
| D2332 |
|
423 |
279 |
$37K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
50 |
40 |
$20K |
| D2335 |
|
184 |
118 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
1,547 |
464 |
$17K |
| D2950 |
|
92 |
86 |
$12K |
| D4910 |
|
82 |
81 |
$10K |
| D1206 |
Topical application of fluoride varnish |
336 |
329 |
$8K |
| D0431 |
|
646 |
642 |
$6K |
| D2331 |
|
41 |
24 |
$3K |
| D1120 |
Prophylaxis - child |
16 |
16 |
$1K |
| D1321 |
|
18 |
18 |
$195.75 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$193.39 |
| D0270 |
|
29 |
28 |
$178.19 |