| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
50,138 |
18,682 |
$3.37M |
| D0330 |
Panoramic radiographic image |
28,323 |
26,982 |
$1.56M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,723 |
2,548 |
$1.37M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16,319 |
9,625 |
$1.03M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33,070 |
31,416 |
$1.03M |
| D1110 |
Prophylaxis - adult |
23,892 |
22,880 |
$995K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,140 |
10,269 |
$952K |
| D0140 |
Limited oral evaluation - problem focused |
21,712 |
20,674 |
$637K |
| D0210 |
Intraoral - complete series of radiographic images |
11,156 |
9,954 |
$564K |
| D0274 |
Bitewings - four radiographic images |
20,968 |
19,899 |
$429K |
| D3320 |
|
945 |
877 |
$373K |
| D0120 |
Periodic oral evaluation - established patient |
15,876 |
15,395 |
$367K |
| D1120 |
Prophylaxis - child |
14,058 |
13,657 |
$346K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,482 |
3,456 |
$331K |
| D0220 |
Intraoral - periapical first radiographic image |
39,669 |
36,438 |
$260K |
| D2740 |
Crown - porcelain/ceramic |
326 |
247 |
$240K |
| D3310 |
|
692 |
516 |
$236K |
| D0230 |
Intraoral - periapical each additional radiographic image |
39,181 |
23,393 |
$229K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,685 |
1,431 |
$228K |
| D2335 |
|
1,914 |
1,273 |
$210K |
| D2330 |
|
2,762 |
1,692 |
$176K |
| D5110 |
|
370 |
334 |
$164K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,005 |
428 |
$153K |
| D1206 |
Topical application of fluoride varnish |
7,091 |
6,866 |
$147K |
| D2950 |
|
1,272 |
1,151 |
$141K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,484 |
7,102 |
$129K |
| D1351 |
Sealant - per tooth |
4,644 |
1,256 |
$128K |
| D2332 |
|
1,397 |
986 |
$125K |
| D5120 |
|
298 |
260 |
$119K |
| D2394 |
|
1,180 |
1,008 |
$110K |
| D2331 |
|
1,147 |
801 |
$87K |
| D0272 |
Bitewings - two radiographic images |
6,186 |
5,895 |
$70K |
| D4341 |
|
610 |
209 |
$68K |
| D7230 |
|
429 |
227 |
$64K |
| D5214 |
|
67 |
59 |
$59K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
851 |
574 |
$47K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
472 |
267 |
$43K |
| D7310 |
|
352 |
147 |
$42K |
| D2140 |
|
727 |
438 |
$30K |
| D8670 |
Periodic orthodontic treatment visit |
76 |
76 |
$29K |
| D0340 |
|
321 |
318 |
$25K |
| D7240 |
Removal of impacted tooth - completely bony |
103 |
54 |
$23K |
| D2160 |
|
263 |
204 |
$17K |
| D7250 |
|
182 |
61 |
$17K |
| D9243 |
|
569 |
114 |
$17K |
| D0270 |
|
3,462 |
3,204 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
273 |
258 |
$12K |
| D0470 |
|
302 |
300 |
$8K |
| D9239 |
|
116 |
102 |
$7K |
| D5213 |
|
14 |
12 |
$7K |
| D0350 |
|
308 |
307 |
$5K |
| D7241 |
|
22 |
13 |
$4K |
| D2954 |
|
32 |
26 |
$3K |
| D1510 |
|
14 |
13 |
$3K |
| D7311 |
|
82 |
56 |
$3K |
| D4342 |
|
37 |
12 |
$2K |
| D7473 |
|
20 |
12 |
$2K |
| D2161 |
|
23 |
16 |
$2K |
| D1320 |
|
134 |
127 |
$1K |
| D2940 |
|
17 |
14 |
$288.00 |
| D1999 |
|
80 |
33 |
$0.00 |
| D1330 |
|
90 |
90 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
33 |
21 |
$0.00 |