| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
9,969 |
3,204 |
$962K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,712 |
3,939 |
$903K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,338 |
1,561 |
$375K |
| D1110 |
Prophylaxis - adult |
7,805 |
7,658 |
$367K |
| D2740 |
Crown - porcelain/ceramic |
630 |
496 |
$363K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,033 |
1,272 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
7,928 |
7,796 |
$193K |
| D0140 |
Limited oral evaluation - problem focused |
5,436 |
5,278 |
$187K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,051 |
3,963 |
$165K |
| D0274 |
Bitewings - four radiographic images |
4,654 |
4,574 |
$138K |
| D0210 |
Intraoral - complete series of radiographic images |
1,793 |
1,746 |
$128K |
| D2950 |
|
760 |
607 |
$96K |
| D0220 |
Intraoral - periapical first radiographic image |
6,158 |
5,999 |
$76K |
| D0330 |
Panoramic radiographic image |
975 |
947 |
$51K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
42 |
38 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
397 |
397 |
$10K |
| D2331 |
|
50 |
36 |
$6K |
| D1120 |
Prophylaxis - child |
106 |
106 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
250 |
250 |
$3K |
| D2332 |
|
18 |
13 |
$3K |
| D2330 |
|
24 |
15 |
$2K |
| D0351 |
|
14 |
14 |
$0.00 |