| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,053 |
2,020 |
$314K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,210 |
3,165 |
$296K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,409 |
2,391 |
$250K |
| D2335 |
|
2,078 |
1,030 |
$168K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
377 |
336 |
$127K |
| D1110 |
Prophylaxis - adult |
4,175 |
3,866 |
$126K |
| D2394 |
|
1,866 |
1,153 |
$126K |
| D0274 |
Bitewings - four radiographic images |
5,583 |
5,196 |
$99K |
| D2332 |
|
1,578 |
917 |
$97K |
| D3310 |
|
445 |
252 |
$93K |
| D3320 |
|
357 |
264 |
$90K |
| D0140 |
Limited oral evaluation - problem focused |
4,370 |
3,848 |
$89K |
| D8030 |
|
1,175 |
1,054 |
$88K |
| D0330 |
Panoramic radiographic image |
2,310 |
2,122 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
5,377 |
5,037 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,480 |
3,188 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,407 |
908 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,620 |
3,372 |
$50K |
| D1120 |
Prophylaxis - child |
2,649 |
2,477 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
10,116 |
8,591 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,795 |
5,591 |
$39K |
| D2752 |
|
79 |
40 |
$29K |
| D2931 |
|
238 |
182 |
$26K |
| D2331 |
|
419 |
265 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,734 |
1,638 |
$16K |
| D0340 |
|
225 |
213 |
$12K |
| D1351 |
Sealant - per tooth |
579 |
154 |
$11K |
| D5110 |
|
26 |
24 |
$9K |
| D2160 |
|
142 |
94 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
172 |
118 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
262 |
217 |
$9K |
| D2330 |
|
182 |
124 |
$8K |
| D2952 |
|
68 |
37 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
71 |
42 |
$6K |
| D4341 |
|
67 |
26 |
$6K |
| D8670 |
Periodic orthodontic treatment visit |
39 |
38 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
226 |
184 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
89 |
58 |
$5K |
| D2140 |
|
82 |
59 |
$3K |
| D0350 |
|
274 |
245 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
12 |
$2K |
| D9996 |
|
12 |
12 |
$14.80 |