| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
51,419 |
13,878 |
$3.00M |
| D0330 |
Panoramic radiographic image |
16,823 |
15,302 |
$727K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
22,373 |
20,493 |
$598K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,577 |
1,240 |
$544K |
| D0140 |
Limited oral evaluation - problem focused |
22,669 |
20,645 |
$502K |
| D1110 |
Prophylaxis - adult |
11,151 |
10,477 |
$379K |
| D1120 |
Prophylaxis - child |
14,897 |
13,735 |
$336K |
| D0120 |
Periodic oral evaluation - established patient |
12,640 |
11,804 |
$246K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,468 |
2,354 |
$219K |
| D1206 |
Topical application of fluoride varnish |
10,510 |
9,877 |
$200K |
| D0274 |
Bitewings - four radiographic images |
9,870 |
9,076 |
$157K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,593 |
1,647 |
$150K |
| D7240 |
Removal of impacted tooth - completely bony |
547 |
224 |
$99K |
| D0272 |
Bitewings - two radiographic images |
7,161 |
6,531 |
$81K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,124 |
593 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
13,141 |
11,980 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,717 |
4,198 |
$62K |
| D1351 |
Sealant - per tooth |
2,049 |
613 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
470 |
319 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
1,253 |
823 |
$39K |
| D2950 |
|
348 |
292 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,142 |
2,209 |
$28K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
70 |
67 |
$26K |
| D7230 |
|
169 |
78 |
$26K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
357 |
133 |
$22K |
| D0240 |
|
1,287 |
886 |
$19K |
| D5110 |
|
45 |
39 |
$15K |
| D9222 |
|
106 |
92 |
$13K |
| D7310 |
|
119 |
29 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
16 |
13 |
$12K |
| D2331 |
|
81 |
60 |
$7K |
| D2330 |
|
134 |
68 |
$7K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
64 |
50 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
81 |
51 |
$4K |
| D2140 |
|
89 |
38 |
$4K |
| D4342 |
|
34 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31 |
25 |
$1K |
| D0180 |
|
16 |
14 |
$347.83 |