| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
33,863 |
8,255 |
$2.12M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,813 |
8,519 |
$1.06M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
9,162 |
5,367 |
$655K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,462 |
5,658 |
$603K |
| D1110 |
Prophylaxis - adult |
13,083 |
12,617 |
$476K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,712 |
14,038 |
$413K |
| D0330 |
Panoramic radiographic image |
8,655 |
8,289 |
$392K |
| D0120 |
Periodic oral evaluation - established patient |
18,627 |
18,031 |
$350K |
| D0274 |
Bitewings - four radiographic images |
17,325 |
16,588 |
$307K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
497 |
424 |
$278K |
| D0210 |
Intraoral - complete series of radiographic images |
3,955 |
3,837 |
$256K |
| D2331 |
|
2,798 |
1,278 |
$217K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,303 |
9,940 |
$170K |
| D2335 |
|
1,526 |
735 |
$149K |
| D1120 |
Prophylaxis - child |
6,048 |
5,843 |
$131K |
| D2394 |
|
1,202 |
766 |
$102K |
| D2740 |
Crown - porcelain/ceramic |
90 |
51 |
$72K |
| D2332 |
|
822 |
446 |
$65K |
| D2330 |
|
937 |
565 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,394 |
5,719 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
10,579 |
10,139 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,670 |
1,627 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
652 |
341 |
$35K |
| D3320 |
|
55 |
43 |
$25K |
| D4341 |
|
146 |
60 |
$23K |
| D2160 |
|
288 |
165 |
$19K |
| D1351 |
Sealant - per tooth |
398 |
83 |
$15K |
| D3310 |
|
41 |
29 |
$15K |
| D7310 |
|
112 |
37 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,444 |
1,391 |
$14K |
| D4342 |
|
99 |
38 |
$13K |
| D2140 |
|
252 |
146 |
$10K |
| D5110 |
|
12 |
12 |
$9K |
| D7220 |
|
49 |
24 |
$5K |
| D2161 |
|
21 |
12 |
$2K |