| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,139 |
451 |
$214K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,303 |
433 |
$136K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
609 |
371 |
$78K |
| D2740 |
Crown - porcelain/ceramic |
74 |
41 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
214 |
138 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,585 |
2,330 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,032 |
945 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
669 |
654 |
$26K |
| D1110 |
Prophylaxis - adult |
598 |
563 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
514 |
491 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
333 |
320 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
495 |
472 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
12 |
$5K |
| D2950 |
|
33 |
13 |
$4K |
| D0330 |
Panoramic radiographic image |
80 |
80 |
$4K |
| D9110 |
|
34 |
29 |
$2K |
| D2330 |
|
15 |
13 |
$1K |