| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,068 |
606 |
$160K |
| D0330 |
Panoramic radiographic image |
1,323 |
985 |
$54K |
| D1110 |
Prophylaxis - adult |
1,452 |
1,036 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
694 |
266 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,529 |
1,066 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
502 |
203 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
426 |
192 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
993 |
693 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
517 |
371 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,221 |
804 |
$12K |
| D2160 |
|
147 |
76 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,909 |
1,275 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
20 |
13 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
113 |
52 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
315 |
230 |
$6K |
| D2331 |
|
114 |
60 |
$6K |
| D2950 |
|
115 |
66 |
$6K |
| D0180 |
|
235 |
174 |
$5K |
| D9243 |
|
120 |
29 |
$5K |
| D7230 |
|
29 |
13 |
$5K |
| D7240 |
Removal of impacted tooth - completely bony |
27 |
12 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
264 |
173 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
210 |
88 |
$3K |
| D2140 |
|
83 |
48 |
$3K |
| D1120 |
Prophylaxis - child |
115 |
81 |
$2K |
| D2931 |
|
18 |
14 |
$2K |
| D2330 |
|
54 |
29 |
$2K |
| D2332 |
|
23 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
155 |
122 |
$1K |
| D0270 |
|
139 |
107 |
$477.00 |
| D9248 |
|
26 |
25 |
$120.00 |
| D9310 |
|
75 |
72 |
$0.00 |