| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
23,361 |
9,391 |
$1.21M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,203 |
7,245 |
$711K |
| D1110 |
Prophylaxis - adult |
14,653 |
14,604 |
$568K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
902 |
885 |
$521K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,479 |
6,183 |
$475K |
| D0140 |
Limited oral evaluation - problem focused |
15,450 |
14,741 |
$471K |
| D2740 |
Crown - porcelain/ceramic |
884 |
653 |
$444K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,068 |
12,007 |
$381K |
| D0120 |
Periodic oral evaluation - established patient |
11,525 |
11,492 |
$283K |
| D0210 |
Intraoral - complete series of radiographic images |
6,008 |
5,924 |
$281K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,968 |
2,641 |
$267K |
| D0330 |
Panoramic radiographic image |
6,934 |
6,898 |
$265K |
| D2331 |
|
3,904 |
2,898 |
$264K |
| D1120 |
Prophylaxis - child |
5,885 |
5,874 |
$228K |
| D2330 |
|
3,715 |
2,574 |
$198K |
| D2332 |
|
2,141 |
1,693 |
$177K |
| D2335 |
|
1,686 |
1,288 |
$175K |
| D3320 |
|
390 |
378 |
$169K |
| D5110 |
|
345 |
343 |
$167K |
| D1206 |
Topical application of fluoride varnish |
12,898 |
12,860 |
$159K |
| D0274 |
Bitewings - four radiographic images |
6,514 |
6,482 |
$155K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
829 |
621 |
$152K |
| D2950 |
|
1,203 |
1,036 |
$152K |
| D0220 |
Intraoral - periapical first radiographic image |
12,947 |
12,562 |
$144K |
| D3310 |
|
282 |
261 |
$97K |
| D5214 |
|
115 |
113 |
$79K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
987 |
790 |
$78K |
| D0272 |
Bitewings - two radiographic images |
2,536 |
2,529 |
$54K |
| D4910 |
|
1,558 |
1,551 |
$52K |
| D4341 |
|
558 |
267 |
$52K |
| D1351 |
Sealant - per tooth |
1,826 |
755 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,939 |
4,216 |
$50K |
| D2394 |
|
450 |
404 |
$47K |
| D2792 |
|
89 |
83 |
$46K |
| D9310 |
|
666 |
663 |
$38K |
| D5120 |
|
76 |
76 |
$37K |
| D4342 |
|
678 |
336 |
$33K |
| D0270 |
|
2,873 |
2,836 |
$25K |
| D2940 |
|
688 |
607 |
$24K |
| D0240 |
|
1,000 |
731 |
$20K |
| D4346 |
|
271 |
271 |
$17K |
| D9920 |
|
328 |
318 |
$7K |
| D0180 |
|
101 |
101 |
$5K |
| D1354 |
|
44 |
12 |
$1K |
| D4355 |
|
12 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
28 |
$824.00 |
| D9248 |
|
13 |
12 |
$684.94 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,158 |
1,078 |
$0.00 |