| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
7,822 |
3,605 |
$442K |
| D1110 |
Prophylaxis - adult |
10,773 |
10,119 |
$365K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
605 |
531 |
$210K |
| D2335 |
|
2,414 |
1,033 |
$196K |
| D0330 |
Panoramic radiographic image |
3,847 |
3,663 |
$185K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,028 |
6,603 |
$183K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,662 |
1,656 |
$157K |
| D0210 |
Intraoral - complete series of radiographic images |
3,184 |
2,802 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
8,216 |
7,721 |
$143K |
| D0140 |
Limited oral evaluation - problem focused |
7,232 |
5,897 |
$142K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,668 |
1,724 |
$130K |
| D0274 |
Bitewings - four radiographic images |
6,284 |
5,876 |
$124K |
| D2394 |
|
1,268 |
921 |
$85K |
| D1320 |
|
3,686 |
3,398 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,703 |
4,437 |
$75K |
| D2740 |
Crown - porcelain/ceramic |
88 |
58 |
$72K |
| D1120 |
Prophylaxis - child |
3,175 |
2,994 |
$66K |
| D2332 |
|
1,033 |
593 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,278 |
816 |
$60K |
| D3320 |
|
205 |
175 |
$53K |
| D2752 |
|
146 |
81 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
10,361 |
8,816 |
$50K |
| D5214 |
|
95 |
91 |
$40K |
| D2950 |
|
197 |
139 |
$28K |
| D2160 |
|
451 |
235 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,556 |
4,206 |
$26K |
| D3310 |
|
120 |
78 |
$24K |
| D7230 |
|
172 |
121 |
$22K |
| D5213 |
|
41 |
38 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
417 |
307 |
$20K |
| D2331 |
|
323 |
245 |
$18K |
| D2330 |
|
360 |
225 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,550 |
1,460 |
$16K |
| D2161 |
|
219 |
127 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
255 |
108 |
$13K |
| D0470 |
|
659 |
356 |
$13K |
| D5110 |
|
33 |
25 |
$9K |
| D2140 |
|
214 |
153 |
$8K |
| D2931 |
|
38 |
26 |
$4K |
| D1351 |
Sealant - per tooth |
143 |
38 |
$3K |
| D2952 |
|
16 |
12 |
$2K |
| D0240 |
|
188 |
101 |
$2K |