| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,096 |
1,064 |
$151K |
| D1110 |
Prophylaxis - adult |
4,898 |
4,697 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,520 |
1,312 |
$124K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,889 |
921 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
5,791 |
5,518 |
$89K |
| D0274 |
Bitewings - four radiographic images |
4,746 |
4,533 |
$85K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,110 |
688 |
$63K |
| D0330 |
Panoramic radiographic image |
1,652 |
1,547 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,140 |
1,083 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,174 |
724 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
2,617 |
2,367 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,111 |
2,044 |
$51K |
| D1120 |
Prophylaxis - child |
2,493 |
2,409 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,610 |
2,512 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
7,041 |
6,575 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,620 |
4,859 |
$26K |
| D2394 |
|
233 |
169 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
34 |
29 |
$11K |
| D4341 |
|
120 |
30 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,038 |
1,002 |
$10K |
| D2335 |
|
100 |
71 |
$8K |
| D3320 |
|
17 |
12 |
$4K |
| D0350 |
|
288 |
272 |
$3K |
| D1351 |
Sealant - per tooth |
112 |
21 |
$2K |
| D2332 |
|
14 |
12 |
$689.58 |
| D2330 |
|
18 |
13 |
$665.73 |
| D0270 |
|
41 |
33 |
$155.00 |