| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
25,840 |
11,448 |
$1.92M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
3,276 |
2,654 |
$1.75M |
| D1110 |
Prophylaxis - adult |
20,399 |
18,877 |
$1.01M |
| D1120 |
Prophylaxis - child |
20,756 |
18,675 |
$944K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,671 |
2,156 |
$936K |
| D2740 |
Crown - porcelain/ceramic |
1,701 |
858 |
$885K |
| D0120 |
Periodic oral evaluation - established patient |
35,007 |
31,675 |
$832K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,204 |
8,296 |
$802K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,536 |
6,938 |
$733K |
| D1206 |
Topical application of fluoride varnish |
28,471 |
25,795 |
$655K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,342 |
816 |
$622K |
| D0140 |
Limited oral evaluation - problem focused |
14,641 |
13,737 |
$578K |
| D3320 |
|
1,149 |
977 |
$506K |
| D0210 |
Intraoral - complete series of radiographic images |
7,484 |
6,748 |
$451K |
| D0330 |
Panoramic radiographic image |
8,110 |
7,326 |
$449K |
| D1351 |
Sealant - per tooth |
12,549 |
4,184 |
$440K |
| D0274 |
Bitewings - four radiographic images |
12,388 |
11,252 |
$420K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,224 |
9,414 |
$396K |
| D3310 |
|
1,050 |
745 |
$381K |
| D2331 |
|
3,951 |
2,655 |
$315K |
| D0272 |
Bitewings - two radiographic images |
10,429 |
9,413 |
$280K |
| D4341 |
|
3,044 |
1,195 |
$236K |
| D0220 |
Intraoral - periapical first radiographic image |
15,903 |
14,270 |
$236K |
| D2330 |
|
3,399 |
2,233 |
$235K |
| D4342 |
|
3,679 |
1,895 |
$234K |
| D2332 |
|
1,916 |
1,397 |
$207K |
| D2954 |
|
1,491 |
1,136 |
$207K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,466 |
1,909 |
$203K |
| D3348 |
|
291 |
286 |
$168K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,204 |
1,705 |
$163K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,246 |
1,643 |
$162K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,265 |
425 |
$161K |
| D2335 |
|
1,201 |
820 |
$144K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,328 |
5,237 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,695 |
4,117 |
$90K |
| D2140 |
|
1,329 |
1,013 |
$89K |
| D5110 |
|
84 |
84 |
$49K |
| D0270 |
|
3,901 |
3,676 |
$47K |
| D2950 |
|
261 |
224 |
$41K |
| D9248 |
|
1,095 |
958 |
$35K |
| D2160 |
|
342 |
311 |
$29K |
| D1354 |
|
1,353 |
451 |
$18K |
| D7230 |
|
63 |
33 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
597 |
574 |
$15K |
| D5120 |
|
25 |
25 |
$15K |
| D5211 |
|
12 |
12 |
$6K |
| D3347 |
|
14 |
12 |
$5K |
| D0180 |
|
151 |
151 |
$5K |
| D9110 |
|
125 |
121 |
$4K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
40 |
12 |
$4K |
| D0240 |
|
161 |
134 |
$2K |
| D4346 |
|
29 |
28 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
37 |
37 |
$9.19 |
| D9944 |
|
65 |
64 |
$0.00 |
| D4910 |
|
14 |
13 |
$0.00 |
| D0160 |
|
82 |
80 |
$0.00 |
| D7953 |
|
13 |
12 |
$0.00 |
| D3332 |
|
38 |
37 |
$0.00 |