| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,533 |
1,531 |
$299K |
| D0330 |
Panoramic radiographic image |
1,854 |
1,804 |
$89K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,605 |
982 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
4,444 |
4,357 |
$82K |
| D1110 |
Prophylaxis - adult |
2,320 |
2,270 |
$82K |
| D2140 |
|
1,821 |
860 |
$69K |
| D2331 |
|
977 |
476 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
2,606 |
2,543 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
790 |
334 |
$55K |
| D1120 |
Prophylaxis - child |
2,077 |
2,041 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,638 |
2,596 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
425 |
261 |
$34K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
460 |
173 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,550 |
1,504 |
$30K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
259 |
52 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,286 |
3,103 |
$18K |
| D2160 |
|
287 |
228 |
$17K |
| D2335 |
|
169 |
116 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,275 |
1,257 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
120 |
102 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,352 |
1,944 |
$12K |
| D1351 |
Sealant - per tooth |
378 |
116 |
$9K |
| D3310 |
|
29 |
27 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
14 |
$6K |
| D7230 |
|
24 |
12 |
$3K |
| D2332 |
|
37 |
26 |
$2K |
| D2394 |
|
17 |
14 |
$1K |
| D2161 |
|
16 |
13 |
$1K |