| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
20,142 |
5,881 |
$1.73M |
| D5110 |
|
1,048 |
1,028 |
$892K |
| D0330 |
Panoramic radiographic image |
10,712 |
10,606 |
$714K |
| D1110 |
Prophylaxis - adult |
13,247 |
13,110 |
$644K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,327 |
2,612 |
$641K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,404 |
3,839 |
$492K |
| D0274 |
Bitewings - four radiographic images |
13,831 |
13,691 |
$490K |
| D5120 |
|
582 |
572 |
$469K |
| D0120 |
Periodic oral evaluation - established patient |
15,195 |
15,048 |
$442K |
| D0140 |
Limited oral evaluation - problem focused |
13,249 |
12,946 |
$440K |
| D1206 |
Topical application of fluoride varnish |
16,697 |
16,525 |
$400K |
| D2160 |
|
2,779 |
1,917 |
$261K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,083 |
1,938 |
$259K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,046 |
6,985 |
$252K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,569 |
2,195 |
$240K |
| D2140 |
|
3,780 |
2,418 |
$231K |
| D0220 |
Intraoral - periapical first radiographic image |
12,390 |
12,108 |
$165K |
| D1120 |
Prophylaxis - child |
4,662 |
4,624 |
$154K |
| D2331 |
|
1,612 |
1,044 |
$149K |
| D2330 |
|
1,981 |
1,249 |
$142K |
| D2335 |
|
1,464 |
1,021 |
$135K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,315 |
989 |
$125K |
| D2332 |
|
1,144 |
746 |
$109K |
| D1351 |
Sealant - per tooth |
4,291 |
1,084 |
$108K |
| D0272 |
Bitewings - two radiographic images |
2,403 |
2,383 |
$63K |
| D2161 |
|
230 |
184 |
$30K |
| D1330 |
|
2,488 |
2,430 |
$29K |
| D2394 |
|
349 |
299 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,201 |
1,712 |
$19K |
| D5212 |
|
25 |
24 |
$14K |
| D3320 |
|
43 |
40 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
480 |
411 |
$6K |
| D4355 |
|
121 |
118 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$620.16 |
| D7240 |
Removal of impacted tooth - completely bony |
36 |
12 |
$0.00 |
| D3310 |
|
13 |
12 |
$0.00 |