| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,066 |
2,274 |
$386K |
| D1110 |
Prophylaxis - adult |
8,779 |
8,553 |
$345K |
| D0120 |
Periodic oral evaluation - established patient |
9,257 |
9,031 |
$175K |
| D0330 |
Panoramic radiographic image |
2,984 |
2,906 |
$149K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,099 |
4,000 |
$130K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,377 |
941 |
$108K |
| D0274 |
Bitewings - four radiographic images |
5,521 |
5,347 |
$107K |
| D2740 |
Crown - porcelain/ceramic |
113 |
79 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
907 |
882 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,297 |
893 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,879 |
4,784 |
$82K |
| D1120 |
Prophylaxis - child |
3,543 |
3,491 |
$79K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,087 |
715 |
$57K |
| D2931 |
|
415 |
346 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
388 |
291 |
$47K |
| D2140 |
|
986 |
620 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,114 |
1,062 |
$33K |
| D2330 |
|
462 |
285 |
$31K |
| D2332 |
|
206 |
130 |
$26K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
42 |
39 |
$25K |
| D3310 |
|
48 |
25 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
3,921 |
3,648 |
$21K |
| D2394 |
|
125 |
103 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,637 |
1,022 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,535 |
1,503 |
$14K |
| D3320 |
|
15 |
13 |
$9K |
| D1206 |
Topical application of fluoride varnish |
225 |
221 |
$7K |
| D2335 |
|
27 |
18 |
$5K |
| D9944 |
|
12 |
12 |
$5K |
| D2331 |
|
64 |
52 |
$5K |
| D2160 |
|
79 |
52 |
$4K |
| D1351 |
Sealant - per tooth |
177 |
40 |
$4K |
| D0180 |
|
44 |
43 |
$1K |
| D0350 |
|
21 |
13 |
$205.55 |
| D1999 |
|
1,710 |
1,449 |
$0.00 |