| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,904 |
2,255 |
$317K |
| D1110 |
Prophylaxis - adult |
6,135 |
5,890 |
$199K |
| D0210 |
Intraoral - complete series of radiographic images |
2,868 |
2,681 |
$165K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,562 |
4,308 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
6,715 |
6,446 |
$120K |
| D0274 |
Bitewings - four radiographic images |
4,862 |
4,695 |
$93K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
234 |
225 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,544 |
1,032 |
$84K |
| D2931 |
|
746 |
623 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,980 |
2,874 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
830 |
514 |
$41K |
| D0330 |
Panoramic radiographic image |
923 |
883 |
$40K |
| D1120 |
Prophylaxis - child |
1,897 |
1,822 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,661 |
1,575 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,998 |
3,851 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,551 |
3,386 |
$17K |
| D2740 |
Crown - porcelain/ceramic |
16 |
14 |
$13K |
| D0272 |
Bitewings - two radiographic images |
998 |
949 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
44 |
$3K |