| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
60,317 |
60,306 |
$3.38M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15,273 |
9,184 |
$2.49M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19,896 |
14,147 |
$2.09M |
| D2750 |
|
2,856 |
2,212 |
$2.05M |
| D0120 |
Periodic oral evaluation - established patient |
63,719 |
63,700 |
$1.88M |
| D1120 |
Prophylaxis - child |
39,501 |
39,495 |
$1.76M |
| D1351 |
Sealant - per tooth |
27,371 |
10,698 |
$1.58M |
| D0274 |
Bitewings - four radiographic images |
50,469 |
50,467 |
$1.45M |
| D0210 |
Intraoral - complete series of radiographic images |
23,572 |
23,543 |
$1.14M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
7,982 |
6,401 |
$1.05M |
| D7240 |
Removal of impacted tooth - completely bony |
2,350 |
1,473 |
$1.04M |
| D0220 |
Intraoral - periapical first radiographic image |
70,061 |
69,857 |
$968K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29,625 |
29,613 |
$877K |
| D9310 |
|
8,595 |
8,593 |
$695K |
| D1208 |
Topical application of fluoride, excluding varnish |
42,046 |
42,036 |
$681K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,302 |
5,690 |
$636K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,454 |
2,844 |
$604K |
| D1206 |
Topical application of fluoride varnish |
17,623 |
17,618 |
$553K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56,251 |
55,638 |
$504K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,378 |
2,833 |
$483K |
| D2954 |
|
2,605 |
1,984 |
$420K |
| D0240 |
|
16,816 |
12,171 |
$407K |
| D0272 |
Bitewings - two radiographic images |
20,438 |
20,435 |
$394K |
| D0330 |
Panoramic radiographic image |
8,677 |
8,677 |
$379K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
10,815 |
9,919 |
$288K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,120 |
2,993 |
$278K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,856 |
1,852 |
$273K |
| D2335 |
|
422 |
347 |
$165K |
| D0140 |
Limited oral evaluation - problem focused |
7,492 |
7,463 |
$151K |
| D7230 |
|
557 |
516 |
$133K |
| D9222 |
|
1,671 |
1,670 |
$125K |
| D1353 |
|
7,176 |
1,277 |
$81K |
| D2394 |
|
430 |
359 |
$78K |
| D1354 |
|
3,637 |
1,161 |
$78K |
| D9110 |
|
2,301 |
2,284 |
$75K |
| D9243 |
|
400 |
399 |
$70K |
| D4910 |
|
1,324 |
1,323 |
$69K |
| D3320 |
|
146 |
124 |
$64K |
| D2332 |
|
506 |
288 |
$56K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
113 |
103 |
$56K |
| D2331 |
|
314 |
157 |
$29K |
| D9239 |
|
398 |
398 |
$26K |
| D4341 |
|
289 |
134 |
$19K |
| D2330 |
|
111 |
65 |
$8K |
| D0270 |
|
553 |
553 |
$7K |
| D4342 |
|
187 |
95 |
$6K |
| D3240 |
|
33 |
19 |
$3K |
| D1516 |
|
13 |
13 |
$2K |
| D9248 |
|
334 |
334 |
$2K |
| D1517 |
|
12 |
12 |
$2K |
| D0160 |
|
28 |
28 |
$1K |
| D1999 |
|
109 |
95 |
$0.00 |
| D0431 |
|
75 |
75 |
$0.00 |
| D0180 |
|
12 |
12 |
$0.00 |