| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,756 |
2,393 |
$209K |
| D1110 |
Prophylaxis - adult |
4,604 |
4,604 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,171 |
1,614 |
$96K |
| D0330 |
Panoramic radiographic image |
2,554 |
2,552 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
3,678 |
3,677 |
$61K |
| D0274 |
Bitewings - four radiographic images |
3,344 |
3,341 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
738 |
640 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,628 |
1,160 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
2,125 |
2,081 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,053 |
2,052 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,715 |
2,271 |
$41K |
| D2331 |
|
776 |
494 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
3,975 |
3,873 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
599 |
372 |
$20K |
| D2950 |
|
145 |
124 |
$19K |
| D2330 |
|
338 |
223 |
$10K |
| D5110 |
|
13 |
13 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
137 |
101 |
$4K |
| D2394 |
|
44 |
39 |
$4K |
| D2332 |
|
68 |
50 |
$3K |
| D2160 |
|
60 |
50 |
$2K |
| D2335 |
|
30 |
24 |
$2K |