| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
27,064 |
26,695 |
$1.12M |
| D0330 |
Panoramic radiographic image |
17,079 |
16,830 |
$1.03M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
9,769 |
4,745 |
$946K |
| D7140 |
Extraction, erupted tooth or exposed root |
12,909 |
6,641 |
$915K |
| D1206 |
Topical application of fluoride varnish |
39,424 |
38,949 |
$841K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15,649 |
8,237 |
$767K |
| D0274 |
Bitewings - four radiographic images |
24,296 |
23,963 |
$703K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,585 |
7,213 |
$698K |
| D0140 |
Limited oral evaluation - problem focused |
24,307 |
22,769 |
$670K |
| D1351 |
Sealant - per tooth |
20,779 |
4,045 |
$602K |
| D0120 |
Periodic oral evaluation - established patient |
24,423 |
24,121 |
$592K |
| D5212 |
|
865 |
841 |
$559K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,646 |
15,444 |
$471K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,229 |
4,179 |
$438K |
| D0230 |
Intraoral - periapical each additional radiographic image |
54,159 |
21,172 |
$438K |
| D2140 |
|
8,352 |
4,019 |
$411K |
| D0220 |
Intraoral - periapical first radiographic image |
35,823 |
33,835 |
$396K |
| D5110 |
|
517 |
472 |
$390K |
| D1120 |
Prophylaxis - child |
13,872 |
13,744 |
$385K |
| D5211 |
|
652 |
631 |
$341K |
| D2331 |
|
3,771 |
2,269 |
$285K |
| D2335 |
|
2,797 |
1,928 |
$280K |
| D2160 |
|
3,095 |
2,368 |
$250K |
| D2330 |
|
4,154 |
2,449 |
$231K |
| D2332 |
|
2,224 |
1,554 |
$192K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,680 |
2,136 |
$189K |
| D0272 |
Bitewings - two radiographic images |
7,310 |
7,241 |
$182K |
| D1330 |
|
6,937 |
6,872 |
$151K |
| D5120 |
|
166 |
158 |
$151K |
| D3320 |
|
347 |
332 |
$133K |
| D0240 |
|
4,584 |
2,310 |
$120K |
| D2161 |
|
1,184 |
978 |
$120K |
| D7250 |
|
419 |
145 |
$65K |
| D9110 |
|
1,863 |
1,793 |
$64K |
| D4341 |
|
250 |
95 |
$52K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
663 |
148 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,657 |
3,388 |
$51K |
| D3310 |
|
163 |
134 |
$51K |
| D7240 |
Removal of impacted tooth - completely bony |
241 |
105 |
$45K |
| D9243 |
|
317 |
109 |
$37K |
| D0145 |
Oral evaluation for a patient under three years of age |
761 |
760 |
$27K |
| D4355 |
|
778 |
774 |
$26K |
| D2394 |
|
380 |
328 |
$20K |
| D7230 |
|
171 |
105 |
$19K |
| D9239 |
|
100 |
97 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
103 |
40 |
$7K |
| D7111 |
|
103 |
79 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$3K |
| D9310 |
|
29 |
28 |
$1K |
| D2940 |
|
28 |
25 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$365.85 |
| D9612 |
|
33 |
25 |
$334.26 |
| D5422 |
|
15 |
15 |
$301.41 |
| D9420 |
|
38 |
38 |
$86.46 |