| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,151 |
2,025 |
$588K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,741 |
2,343 |
$399K |
| D0330 |
Panoramic radiographic image |
3,421 |
3,386 |
$352K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,959 |
4,893 |
$270K |
| D1206 |
Topical application of fluoride varnish |
7,679 |
7,575 |
$270K |
| D1110 |
Prophylaxis - adult |
3,447 |
3,401 |
$231K |
| D1120 |
Prophylaxis - child |
4,858 |
4,811 |
$228K |
| D1330 |
|
5,064 |
4,980 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
4,195 |
4,147 |
$182K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,126 |
1,479 |
$177K |
| D0274 |
Bitewings - four radiographic images |
3,592 |
3,539 |
$172K |
| D0220 |
Intraoral - periapical first radiographic image |
8,423 |
8,271 |
$170K |
| D0140 |
Limited oral evaluation - problem focused |
2,915 |
2,873 |
$142K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,171 |
5,669 |
$109K |
| D0272 |
Bitewings - two radiographic images |
2,493 |
2,470 |
$106K |
| D5110 |
|
82 |
81 |
$99K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
742 |
589 |
$98K |
| D0240 |
|
2,065 |
1,037 |
$90K |
| D1351 |
Sealant - per tooth |
1,639 |
544 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,606 |
2,356 |
$62K |
| D4341 |
|
158 |
70 |
$33K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
111 |
53 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
147 |
97 |
$16K |
| D5120 |
|
14 |
12 |
$16K |
| D0180 |
|
151 |
150 |
$15K |
| D1354 |
|
278 |
62 |
$10K |
| D4342 |
|
58 |
25 |
$10K |
| D2332 |
|
49 |
40 |
$8K |
| D4910 |
|
54 |
54 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
70 |
70 |
$4K |
| D2331 |
|
31 |
25 |
$4K |
| D2140 |
|
38 |
26 |
$3K |
| D2950 |
|
12 |
12 |
$2K |