| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
8,280 |
3,353 |
$528K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,088 |
550 |
$231K |
| D1110 |
Prophylaxis - adult |
3,120 |
3,096 |
$118K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
947 |
580 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
6,867 |
6,806 |
$113K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,565 |
1,005 |
$108K |
| D1120 |
Prophylaxis - child |
3,911 |
3,874 |
$106K |
| D0330 |
Panoramic radiographic image |
2,171 |
2,136 |
$105K |
| D5110 |
|
151 |
147 |
$101K |
| D1206 |
Topical application of fluoride varnish |
5,119 |
5,075 |
$87K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
801 |
243 |
$58K |
| D2331 |
|
672 |
310 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
720 |
487 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,335 |
1,308 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
257 |
196 |
$24K |
| D5120 |
|
34 |
32 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,334 |
1,319 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,056 |
2,003 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
456 |
435 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
272 |
258 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
172 |
107 |
$2K |
| D1351 |
Sealant - per tooth |
165 |
43 |
$0.00 |