| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
35,196 |
18,785 |
$2.97M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32,596 |
20,939 |
$2.54M |
| D0120 |
Periodic oral evaluation - established patient |
69,119 |
68,605 |
$2.20M |
| D1206 |
Topical application of fluoride varnish |
80,680 |
80,027 |
$2.03M |
| D1120 |
Prophylaxis - child |
52,848 |
52,455 |
$1.83M |
| D1110 |
Prophylaxis - adult |
36,610 |
36,290 |
$1.72M |
| D0330 |
Panoramic radiographic image |
16,409 |
16,256 |
$1.48M |
| D0220 |
Intraoral - periapical first radiographic image |
86,056 |
83,924 |
$1.31M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,649 |
3,064 |
$1.27M |
| D0140 |
Limited oral evaluation - problem focused |
35,956 |
34,932 |
$1.22M |
| D0274 |
Bitewings - four radiographic images |
33,242 |
32,966 |
$1.18M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20,455 |
13,815 |
$1.18M |
| D1330 |
|
40,480 |
39,903 |
$1.06M |
| D0230 |
Intraoral - periapical each additional radiographic image |
75,921 |
58,578 |
$890K |
| D1351 |
Sealant - per tooth |
30,142 |
8,601 |
$885K |
| D0272 |
Bitewings - two radiographic images |
28,065 |
27,848 |
$871K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20,800 |
20,624 |
$810K |
| D0240 |
|
25,506 |
12,673 |
$759K |
| D1354 |
|
20,803 |
4,475 |
$645K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,101 |
4,261 |
$415K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,488 |
2,500 |
$351K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,105 |
3,032 |
$325K |
| D2335 |
|
3,340 |
2,419 |
$302K |
| D5110 |
|
360 |
355 |
$273K |
| D2934 |
|
969 |
256 |
$245K |
| D4341 |
|
1,282 |
510 |
$226K |
| D2331 |
|
3,074 |
2,369 |
$214K |
| D2332 |
|
2,432 |
1,853 |
$206K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,663 |
1,676 |
$190K |
| D2160 |
|
1,744 |
1,481 |
$176K |
| D2330 |
|
2,890 |
2,036 |
$155K |
| D2140 |
|
2,101 |
1,568 |
$121K |
| D2161 |
|
777 |
667 |
$96K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,977 |
2,962 |
$94K |
| D5120 |
|
93 |
90 |
$77K |
| D1510 |
|
469 |
354 |
$65K |
| D3320 |
|
226 |
214 |
$50K |
| D2394 |
|
685 |
601 |
$38K |
| D5212 |
|
53 |
53 |
$31K |
| D9920 |
|
1,186 |
1,078 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,989 |
1,759 |
$30K |
| D9110 |
|
1,009 |
965 |
$30K |
| D9420 |
|
1,175 |
739 |
$27K |
| D2940 |
|
407 |
246 |
$18K |
| D2950 |
|
192 |
178 |
$17K |
| D4910 |
|
279 |
277 |
$12K |
| D3310 |
|
31 |
27 |
$10K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
244 |
213 |
$9K |
| D4355 |
|
332 |
330 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
28 |
26 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
57 |
57 |
$6K |
| D0273 |
|
100 |
96 |
$3K |
| D2931 |
|
15 |
13 |
$2K |
| D0270 |
|
55 |
55 |
$660.83 |
| D1515 |
|
22 |
12 |
$270.53 |
| D9985 |
|
990 |
892 |
$70.13 |
| D1999 |
|
26 |
24 |
$0.00 |