| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,980 |
1,974 |
$324K |
| D2740 |
Crown - porcelain/ceramic |
270 |
162 |
$234K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,188 |
1,628 |
$208K |
| D0330 |
Panoramic radiographic image |
3,682 |
3,464 |
$195K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
244 |
208 |
$131K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,779 |
3,525 |
$117K |
| D2950 |
|
1,183 |
864 |
$111K |
| D1110 |
Prophylaxis - adult |
2,938 |
2,800 |
$110K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,548 |
943 |
$110K |
| D0274 |
Bitewings - four radiographic images |
4,443 |
4,172 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
4,085 |
3,887 |
$82K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,113 |
603 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
2,373 |
2,203 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,967 |
2,503 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
5,625 |
5,138 |
$36K |
| D2335 |
|
348 |
169 |
$34K |
| D3320 |
|
91 |
74 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,918 |
1,852 |
$32K |
| D4342 |
|
319 |
91 |
$28K |
| D2394 |
|
334 |
215 |
$27K |
| D1120 |
Prophylaxis - child |
1,018 |
988 |
$22K |
| D0180 |
|
456 |
442 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
183 |
88 |
$11K |
| D2332 |
|
137 |
81 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
215 |
184 |
$8K |
| D7230 |
|
37 |
26 |
$6K |
| D5214 |
|
12 |
12 |
$5K |
| D2160 |
|
54 |
29 |
$4K |
| D1351 |
Sealant - per tooth |
138 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
235 |
224 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
36 |
26 |
$2K |
| D4910 |
|
34 |
28 |
$2K |
| D2331 |
|
24 |
19 |
$2K |
| D1320 |
|
15 |
13 |
$197.70 |