| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D5110 |
|
1,482 |
1,306 |
$602K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,626 |
1,797 |
$431K |
| D5120 |
|
904 |
797 |
$370K |
| D0330 |
Panoramic radiographic image |
6,287 |
5,828 |
$270K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,730 |
7,260 |
$222K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,816 |
953 |
$220K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,188 |
2,085 |
$193K |
| D1110 |
Prophylaxis - adult |
4,326 |
4,127 |
$163K |
| D0210 |
Intraoral - complete series of radiographic images |
4,500 |
3,309 |
$132K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,615 |
1,187 |
$119K |
| D5214 |
|
206 |
197 |
$117K |
| D0274 |
Bitewings - four radiographic images |
6,674 |
6,227 |
$110K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,746 |
1,041 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
4,941 |
4,731 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,475 |
7,603 |
$75K |
| D2332 |
|
563 |
337 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
8,891 |
8,166 |
$43K |
| D2335 |
|
397 |
214 |
$35K |
| D5213 |
|
37 |
37 |
$25K |
| D2740 |
Crown - porcelain/ceramic |
17 |
15 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
471 |
439 |
$11K |
| D1320 |
|
615 |
577 |
$8K |
| D1120 |
Prophylaxis - child |
354 |
326 |
$8K |
| D1206 |
Topical application of fluoride varnish |
481 |
445 |
$7K |
| D2330 |
|
86 |
51 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
98 |
65 |
$5K |
| D4341 |
|
63 |
25 |
$5K |
| D0272 |
Bitewings - two radiographic images |
519 |
493 |
$3K |
| D2160 |
|
46 |
37 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
150 |
146 |
$2K |
| D2331 |
|
19 |
12 |
$888.86 |
| D2394 |
|
13 |
12 |
$682.86 |