| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
10,218 |
3,471 |
$442K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,494 |
2,811 |
$321K |
| D1110 |
Prophylaxis - adult |
7,893 |
7,871 |
$279K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,194 |
7,162 |
$187K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,916 |
2,050 |
$183K |
| D0140 |
Limited oral evaluation - problem focused |
6,736 |
6,548 |
$163K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,052 |
1,495 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
6,652 |
6,634 |
$147K |
| D0330 |
Panoramic radiographic image |
3,980 |
3,956 |
$136K |
| D0274 |
Bitewings - four radiographic images |
5,746 |
5,722 |
$110K |
| D0210 |
Intraoral - complete series of radiographic images |
3,949 |
3,236 |
$104K |
| D0220 |
Intraoral - periapical first radiographic image |
11,990 |
11,527 |
$98K |
| D1120 |
Prophylaxis - child |
2,575 |
2,572 |
$98K |
| D5110 |
|
193 |
193 |
$95K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,753 |
1,217 |
$84K |
| D1206 |
Topical application of fluoride varnish |
2,643 |
2,640 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,367 |
7,387 |
$56K |
| D2332 |
|
402 |
294 |
$31K |
| D1351 |
Sealant - per tooth |
994 |
243 |
$27K |
| D2331 |
|
395 |
286 |
$24K |
| D2330 |
|
483 |
295 |
$21K |
| D5120 |
|
38 |
38 |
$19K |
| D2335 |
|
151 |
117 |
$14K |
| D2394 |
|
168 |
136 |
$13K |
| D2740 |
Crown - porcelain/ceramic |
21 |
13 |
$10K |
| D2950 |
|
60 |
46 |
$9K |
| D7310 |
|
84 |
41 |
$8K |
| D3320 |
|
14 |
12 |
$7K |
| D0272 |
Bitewings - two radiographic images |
340 |
340 |
$7K |
| D2752 |
|
17 |
12 |
$7K |
| D5214 |
|
13 |
13 |
$6K |
| D7220 |
|
59 |
39 |
$5K |
| D4346 |
|
38 |
38 |
$3K |
| D4910 |
|
13 |
13 |
$974.88 |
| D4355 |
|
12 |
12 |
$581.01 |