| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,100 |
1,788 |
$223K |
| D0330 |
Panoramic radiographic image |
3,606 |
3,472 |
$161K |
| D1110 |
Prophylaxis - adult |
3,310 |
3,196 |
$152K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,562 |
1,777 |
$147K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,229 |
4,042 |
$112K |
| D1120 |
Prophylaxis - child |
2,247 |
2,160 |
$104K |
| D0274 |
Bitewings - four radiographic images |
3,302 |
3,157 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,642 |
1,128 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
1,297 |
1,276 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
490 |
396 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
448 |
160 |
$30K |
| D2335 |
|
359 |
237 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,627 |
1,553 |
$25K |
| D2740 |
Crown - porcelain/ceramic |
44 |
31 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,301 |
1,270 |
$19K |
| D2332 |
|
244 |
162 |
$16K |
| D5110 |
|
25 |
24 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
494 |
451 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,262 |
1,207 |
$11K |
| D1351 |
Sealant - per tooth |
217 |
63 |
$4K |
| D2330 |
|
64 |
40 |
$3K |
| D0272 |
Bitewings - two radiographic images |
148 |
140 |
$2K |
| D9110 |
|
72 |
68 |
$2K |
| D7250 |
|
21 |
13 |
$2K |
| D2331 |
|
13 |
12 |
$764.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$89.25 |
| D1330 |
|
21 |
17 |
$0.00 |