| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
16,884 |
5,315 |
$1.10M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,788 |
1,490 |
$760K |
| D0330 |
Panoramic radiographic image |
14,805 |
13,155 |
$708K |
| D1110 |
Prophylaxis - adult |
14,981 |
13,392 |
$584K |
| D2394 |
|
6,669 |
3,731 |
$552K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,918 |
3,848 |
$520K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,840 |
4,165 |
$505K |
| D0274 |
Bitewings - four radiographic images |
21,081 |
18,259 |
$468K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,333 |
12,757 |
$427K |
| D2740 |
Crown - porcelain/ceramic |
483 |
283 |
$381K |
| D0120 |
Periodic oral evaluation - established patient |
16,040 |
14,116 |
$322K |
| D3320 |
|
783 |
591 |
$250K |
| D2335 |
|
1,966 |
867 |
$169K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,121 |
1,177 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
19,964 |
17,044 |
$120K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,553 |
12,322 |
$94K |
| D2332 |
|
1,160 |
565 |
$90K |
| D1120 |
Prophylaxis - child |
4,008 |
3,732 |
$88K |
| D2950 |
|
591 |
405 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
3,423 |
2,978 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,472 |
5,247 |
$80K |
| D1206 |
Topical application of fluoride varnish |
2,539 |
2,098 |
$65K |
| D7230 |
|
434 |
263 |
$62K |
| D5214 |
|
81 |
78 |
$42K |
| D1351 |
Sealant - per tooth |
1,833 |
455 |
$39K |
| D2752 |
|
61 |
30 |
$26K |
| D3310 |
|
104 |
55 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,261 |
2,108 |
$23K |
| D7240 |
Removal of impacted tooth - completely bony |
98 |
55 |
$17K |
| D1320 |
|
1,006 |
987 |
$15K |
| D2161 |
|
183 |
112 |
$14K |
| D2160 |
|
170 |
102 |
$11K |
| D7220 |
|
112 |
74 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
190 |
100 |
$10K |
| D5110 |
|
24 |
24 |
$9K |
| D5213 |
|
12 |
12 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
121 |
117 |
$5K |
| D7310 |
|
47 |
25 |
$4K |
| D2952 |
|
26 |
15 |
$4K |
| D2331 |
|
42 |
25 |
$3K |
| D2140 |
|
56 |
29 |
$2K |
| D2330 |
|
55 |
27 |
$2K |