| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
9,979 |
3,214 |
$457K |
| D1110 |
Prophylaxis - adult |
11,486 |
11,469 |
$434K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,195 |
3,887 |
$429K |
| D0210 |
Intraoral - complete series of radiographic images |
8,057 |
7,964 |
$360K |
| D5110 |
|
595 |
595 |
$324K |
| D2740 |
Crown - porcelain/ceramic |
432 |
302 |
$307K |
| D0120 |
Periodic oral evaluation - established patient |
10,960 |
10,944 |
$253K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,927 |
8,909 |
$244K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,679 |
1,957 |
$230K |
| D0140 |
Limited oral evaluation - problem focused |
8,173 |
8,016 |
$214K |
| D0274 |
Bitewings - four radiographic images |
6,509 |
6,497 |
$161K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,557 |
1,602 |
$160K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,659 |
2,225 |
$145K |
| D0220 |
Intraoral - periapical first radiographic image |
13,821 |
13,586 |
$118K |
| D5120 |
|
209 |
209 |
$111K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,054 |
9,389 |
$105K |
| D2950 |
|
504 |
370 |
$90K |
| D2335 |
|
782 |
486 |
$74K |
| D4341 |
|
405 |
143 |
$60K |
| D1120 |
Prophylaxis - child |
1,146 |
1,145 |
$47K |
| D0330 |
Panoramic radiographic image |
1,457 |
1,455 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,449 |
1,448 |
$34K |
| D4355 |
|
453 |
449 |
$27K |
| D2331 |
|
431 |
311 |
$27K |
| D2332 |
|
290 |
196 |
$23K |
| D2394 |
|
221 |
175 |
$22K |
| D5214 |
|
36 |
36 |
$20K |
| D2330 |
|
436 |
269 |
$20K |
| D5213 |
|
12 |
12 |
$7K |
| D4910 |
|
52 |
52 |
$4K |
| D0272 |
Bitewings - two radiographic images |
189 |
189 |
$4K |
| D7310 |
|
30 |
14 |
$3K |
| D4346 |
|
13 |
13 |
$717.00 |
| D0270 |
|
42 |
42 |
$448.16 |