| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,257 |
1,182 |
$146K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,638 |
942 |
$135K |
| D1110 |
Prophylaxis - adult |
2,277 |
2,262 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,956 |
2,934 |
$82K |
| D0330 |
Panoramic radiographic image |
2,430 |
2,412 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
751 |
459 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,594 |
1,575 |
$43K |
| D0274 |
Bitewings - four radiographic images |
2,557 |
2,541 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
428 |
323 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,941 |
3,830 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,177 |
1,176 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
685 |
542 |
$25K |
| D1120 |
Prophylaxis - child |
475 |
475 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
294 |
216 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,704 |
3,027 |
$17K |
| D1206 |
Topical application of fluoride varnish |
561 |
561 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$8K |
| D2950 |
|
33 |
29 |
$6K |
| D5110 |
|
12 |
12 |
$6K |
| D1351 |
Sealant - per tooth |
76 |
20 |
$2K |
| D2332 |
|
16 |
12 |
$2K |
| D4910 |
|
14 |
14 |
$1K |
| D4355 |
|
16 |
14 |
$1K |