| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
9,818 |
3,338 |
$630K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,200 |
2,243 |
$304K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,464 |
1,746 |
$244K |
| D0140 |
Limited oral evaluation - problem focused |
6,447 |
5,927 |
$162K |
| D0210 |
Intraoral - complete series of radiographic images |
2,889 |
2,621 |
$160K |
| D1110 |
Prophylaxis - adult |
3,868 |
3,577 |
$143K |
| D0330 |
Panoramic radiographic image |
2,764 |
2,582 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,244 |
3,900 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
6,010 |
5,575 |
$113K |
| D0274 |
Bitewings - four radiographic images |
3,955 |
3,678 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,303 |
668 |
$71K |
| D2335 |
|
756 |
398 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
8,370 |
7,602 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,199 |
2,031 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,515 |
2,386 |
$32K |
| D1120 |
Prophylaxis - child |
1,455 |
1,374 |
$31K |
| D2740 |
Crown - porcelain/ceramic |
33 |
12 |
$28K |
| D2332 |
|
333 |
159 |
$25K |
| D2394 |
|
317 |
222 |
$23K |
| D2331 |
|
356 |
179 |
$23K |
| D1351 |
Sealant - per tooth |
326 |
69 |
$7K |
| D2950 |
|
39 |
27 |
$6K |
| D2160 |
|
57 |
32 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
61 |
25 |
$3K |
| D0180 |
|
132 |
127 |
$3K |
| D4341 |
|
30 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
224 |
215 |
$2K |
| D9239 |
|
26 |
25 |
$2K |
| D0270 |
|
269 |
255 |
$1K |