| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,082 |
1,399 |
$297K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,474 |
1,645 |
$172K |
| D1110 |
Prophylaxis - adult |
2,907 |
2,738 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
5,454 |
5,085 |
$118K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,215 |
895 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,631 |
1,134 |
$102K |
| D0330 |
Panoramic radiographic image |
1,579 |
1,476 |
$101K |
| D1120 |
Prophylaxis - child |
3,689 |
3,434 |
$94K |
| D2740 |
Crown - porcelain/ceramic |
110 |
54 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,186 |
3,927 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,179 |
2,079 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
2,680 |
2,428 |
$77K |
| D1351 |
Sealant - per tooth |
1,869 |
458 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,448 |
2,277 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
493 |
391 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,295 |
1,206 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,535 |
2,308 |
$16K |
| D2331 |
|
152 |
111 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
82 |
41 |
$11K |
| D2394 |
|
84 |
66 |
$10K |
| D2330 |
|
162 |
99 |
$9K |
| D1354 |
|
279 |
155 |
$7K |
| D2332 |
|
51 |
39 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
788 |
246 |
$4K |
| D1206 |
Topical application of fluoride varnish |
269 |
236 |
$3K |
| D2335 |
|
16 |
13 |
$3K |
| D0180 |
|
104 |
91 |
$3K |