| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
13,686 |
3,653 |
$1.34M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,884 |
5,283 |
$1.30M |
| D0330 |
Panoramic radiographic image |
11,554 |
9,898 |
$797K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,120 |
2,938 |
$795K |
| D2740 |
Crown - porcelain/ceramic |
1,083 |
458 |
$762K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,524 |
2,493 |
$597K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,277 |
11,614 |
$536K |
| D1120 |
Prophylaxis - child |
10,294 |
8,724 |
$315K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,920 |
470 |
$314K |
| D1110 |
Prophylaxis - adult |
5,741 |
4,916 |
$311K |
| D2335 |
|
2,011 |
555 |
$301K |
| D0120 |
Periodic oral evaluation - established patient |
10,889 |
9,210 |
$296K |
| D2330 |
|
2,725 |
751 |
$204K |
| D1351 |
Sealant - per tooth |
5,319 |
1,228 |
$202K |
| D5213 |
|
199 |
164 |
$189K |
| D1206 |
Topical application of fluoride varnish |
7,499 |
6,625 |
$182K |
| D0140 |
Limited oral evaluation - problem focused |
5,028 |
4,120 |
$181K |
| D5214 |
|
173 |
153 |
$162K |
| D2950 |
|
995 |
468 |
$141K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,261 |
333 |
$134K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,461 |
4,345 |
$124K |
| D2394 |
|
828 |
439 |
$117K |
| D2332 |
|
959 |
379 |
$117K |
| D0274 |
Bitewings - four radiographic images |
3,140 |
2,689 |
$97K |
| D0210 |
Intraoral - complete series of radiographic images |
754 |
702 |
$80K |
| D7310 |
|
311 |
116 |
$58K |
| D7230 |
|
157 |
76 |
$46K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
413 |
159 |
$46K |
| D5110 |
|
55 |
51 |
$38K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
50 |
40 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,819 |
1,523 |
$28K |
| D7240 |
Removal of impacted tooth - completely bony |
73 |
32 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,011 |
1,812 |
$17K |
| D5120 |
|
14 |
13 |
$10K |
| D2954 |
|
69 |
31 |
$7K |
| D2331 |
|
43 |
24 |
$4K |
| D1320 |
|
116 |
114 |
$3K |
| D0240 |
|
103 |
43 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
156 |
106 |
$1K |
| D0431 |
|
23 |
17 |
$0.00 |