| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
19,634 |
7,671 |
$2.08M |
| D8670 |
Periodic orthodontic treatment visit |
6,235 |
5,985 |
$462K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,295 |
2,571 |
$413K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,616 |
2,518 |
$350K |
| D0140 |
Limited oral evaluation - problem focused |
9,309 |
8,931 |
$311K |
| D0330 |
Panoramic radiographic image |
6,791 |
6,685 |
$300K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,801 |
823 |
$287K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,324 |
5,245 |
$285K |
| D1110 |
Prophylaxis - adult |
4,597 |
4,532 |
$284K |
| D1120 |
Prophylaxis - child |
5,398 |
5,303 |
$234K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
301 |
291 |
$217K |
| D0120 |
Periodic oral evaluation - established patient |
7,279 |
7,164 |
$216K |
| D7240 |
Removal of impacted tooth - completely bony |
730 |
353 |
$209K |
| D1206 |
Topical application of fluoride varnish |
7,790 |
7,674 |
$174K |
| D1351 |
Sealant - per tooth |
4,838 |
1,203 |
$165K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
836 |
745 |
$135K |
| D2940 |
|
1,918 |
1,088 |
$96K |
| D7230 |
|
376 |
295 |
$85K |
| D2331 |
|
766 |
602 |
$84K |
| D2330 |
|
861 |
623 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
1,379 |
1,358 |
$77K |
| D2740 |
Crown - porcelain/ceramic |
204 |
163 |
$75K |
| D4341 |
|
883 |
473 |
$74K |
| D0274 |
Bitewings - four radiographic images |
3,053 |
3,008 |
$70K |
| D2332 |
|
456 |
380 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,042 |
2,839 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
5,400 |
5,225 |
$54K |
| D2335 |
|
317 |
267 |
$52K |
| D0272 |
Bitewings - two radiographic images |
3,286 |
3,237 |
$50K |
| D9239 |
|
663 |
652 |
$38K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
176 |
176 |
$28K |
| D2950 |
|
336 |
303 |
$27K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
24 |
24 |
$25K |
| D8660 |
|
156 |
155 |
$23K |
| D3310 |
|
46 |
39 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,746 |
1,712 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
677 |
657 |
$15K |
| D9222 |
|
199 |
199 |
$15K |
| D0240 |
|
1,067 |
1,044 |
$13K |
| D4910 |
|
229 |
229 |
$12K |
| D3320 |
|
16 |
16 |
$10K |
| D3120 |
|
255 |
159 |
$9K |
| D1330 |
|
696 |
677 |
$4K |
| D0270 |
|
339 |
333 |
$3K |
| D2394 |
|
14 |
13 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
13 |
$2K |
| D1354 |
|
137 |
38 |
$1K |
| D4342 |
|
20 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$960.00 |