| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
12,298 |
3,808 |
$961K |
| D2740 |
Crown - porcelain/ceramic |
1,071 |
702 |
$599K |
| D5110 |
|
509 |
509 |
$441K |
| D0330 |
Panoramic radiographic image |
4,108 |
4,069 |
$278K |
| D5120 |
|
325 |
325 |
$265K |
| D4341 |
|
1,590 |
794 |
$255K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,456 |
920 |
$185K |
| D0210 |
Intraoral - complete series of radiographic images |
1,652 |
1,637 |
$160K |
| D1110 |
Prophylaxis - adult |
2,849 |
2,818 |
$157K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,440 |
1,066 |
$138K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,297 |
4,244 |
$126K |
| D0140 |
Limited oral evaluation - problem focused |
3,852 |
3,728 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,440 |
981 |
$108K |
| D0274 |
Bitewings - four radiographic images |
2,812 |
2,804 |
$98K |
| D4342 |
|
884 |
486 |
$83K |
| D2331 |
|
857 |
619 |
$80K |
| D2950 |
|
839 |
653 |
$78K |
| D2330 |
|
969 |
620 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,509 |
2,503 |
$66K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
580 |
481 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
5,222 |
5,011 |
$55K |
| D2332 |
|
414 |
303 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,121 |
2,110 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,897 |
2,471 |
$35K |
| D2335 |
|
240 |
165 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
346 |
258 |
$26K |
| D5214 |
|
14 |
14 |
$12K |
| D2140 |
|
343 |
224 |
$10K |
| D9420 |
|
106 |
106 |
$10K |
| D1120 |
Prophylaxis - child |
80 |
80 |
$4K |
| D0270 |
|
223 |
222 |
$2K |
| D2160 |
|
14 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$770.66 |
| D0170 |
|
13 |
12 |
$392.39 |
| D0190 |
|
468 |
465 |
$195.76 |
| D0180 |
|
33 |
33 |
$33.55 |
| D9995 |
|
34 |
34 |
$0.00 |
| D1999 |
|
51 |
35 |
$0.00 |