| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,775 |
1,296 |
$270K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,416 |
691 |
$80K |
| D1110 |
Prophylaxis - adult |
1,761 |
1,714 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,746 |
1,724 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
921 |
440 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
2,049 |
1,956 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
2,209 |
2,195 |
$43K |
| D0330 |
Panoramic radiographic image |
958 |
942 |
$41K |
| D4342 |
|
303 |
76 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
612 |
559 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,165 |
1,154 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,691 |
1,685 |
$29K |
| D1120 |
Prophylaxis - child |
1,271 |
1,252 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
159 |
108 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,533 |
2,458 |
$15K |
| D0350 |
|
732 |
673 |
$15K |
| D2740 |
Crown - porcelain/ceramic |
21 |
13 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,200 |
1,603 |
$15K |
| D5110 |
|
12 |
12 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
549 |
542 |
$8K |
| D2332 |
|
63 |
39 |
$7K |
| D4910 |
|
82 |
80 |
$5K |
| D2335 |
|
25 |
13 |
$5K |
| D1320 |
|
149 |
148 |
$4K |
| D1351 |
Sealant - per tooth |
70 |
15 |
$3K |
| D2331 |
|
24 |
14 |
$3K |
| D0272 |
Bitewings - two radiographic images |
179 |
179 |
$2K |
| D0240 |
|
61 |
29 |
$1K |
| D9995 |
|
78 |
75 |
$0.00 |