| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,268 |
1,497 |
$281K |
| D1206 |
Topical application of fluoride varnish |
10,647 |
10,292 |
$239K |
| D1351 |
Sealant - per tooth |
9,070 |
2,735 |
$166K |
| D0210 |
Intraoral - complete series of radiographic images |
3,065 |
2,991 |
$142K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,057 |
512 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
3,284 |
3,170 |
$79K |
| D1999 |
|
7,282 |
7,081 |
$70K |
| D1110 |
Prophylaxis - adult |
1,775 |
1,768 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,487 |
2,454 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,228 |
2,209 |
$55K |
| D1120 |
Prophylaxis - child |
1,975 |
1,963 |
$54K |
| D4341 |
|
534 |
254 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
571 |
474 |
$46K |
| D0330 |
Panoramic radiographic image |
2,279 |
2,248 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
689 |
492 |
$39K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
85 |
82 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,572 |
1,554 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
3,094 |
2,984 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
671 |
635 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
199 |
176 |
$18K |
| D0190 |
|
1,050 |
1,028 |
$16K |
| D2950 |
|
193 |
169 |
$15K |
| D2331 |
|
151 |
96 |
$9K |
| D0270 |
|
991 |
961 |
$9K |
| D2330 |
|
145 |
97 |
$8K |
| D0272 |
Bitewings - two radiographic images |
721 |
708 |
$8K |
| D2335 |
|
81 |
64 |
$7K |
| D7250 |
|
70 |
25 |
$7K |
| D2940 |
|
191 |
168 |
$7K |
| D4910 |
|
199 |
175 |
$6K |
| D2740 |
Crown - porcelain/ceramic |
15 |
14 |
$6K |
| D4342 |
|
120 |
66 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
312 |
294 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,358 |
698 |
$5K |
| D7230 |
|
26 |
12 |
$5K |
| D9239 |
|
27 |
27 |
$2K |
| D0180 |
|
27 |
26 |
$685.79 |
| D0273 |
|
59 |
58 |
$550.53 |