| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
14,909 |
3,890 |
$891K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,082 |
5,114 |
$685K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,949 |
3,931 |
$465K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,225 |
3,232 |
$385K |
| D2740 |
Crown - porcelain/ceramic |
444 |
222 |
$358K |
| D0210 |
Intraoral - complete series of radiographic images |
5,666 |
5,321 |
$335K |
| D2335 |
|
3,037 |
1,493 |
$283K |
| D2332 |
|
2,880 |
1,608 |
$223K |
| D1110 |
Prophylaxis - adult |
5,999 |
5,727 |
$202K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,214 |
6,858 |
$198K |
| D2394 |
|
2,586 |
1,577 |
$192K |
| D0120 |
Periodic oral evaluation - established patient |
8,793 |
8,428 |
$154K |
| D0274 |
Bitewings - four radiographic images |
7,465 |
7,156 |
$152K |
| D4342 |
|
1,692 |
684 |
$132K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,344 |
7,996 |
$108K |
| D0220 |
Intraoral - periapical first radiographic image |
10,916 |
10,413 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
940 |
398 |
$50K |
| D0330 |
Panoramic radiographic image |
885 |
824 |
$38K |
| D2330 |
|
679 |
423 |
$37K |
| D2950 |
|
264 |
162 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
2,018 |
1,879 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,345 |
2,231 |
$33K |
| D2160 |
|
396 |
215 |
$25K |
| D2140 |
|
444 |
172 |
$17K |
| D4341 |
|
180 |
62 |
$15K |
| D1120 |
Prophylaxis - child |
789 |
745 |
$14K |
| D2161 |
|
172 |
106 |
$13K |
| D5110 |
|
15 |
15 |
$6K |
| D0272 |
Bitewings - two radiographic images |
611 |
566 |
$6K |
| D3320 |
|
15 |
12 |
$4K |
| D5120 |
|
13 |
13 |
$4K |
| D0350 |
|
111 |
110 |
$2K |
| D2331 |
|
18 |
14 |
$2K |
| D7220 |
|
28 |
13 |
$2K |