| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,193 |
1,378 |
$288K |
| D5110 |
|
378 |
362 |
$233K |
| D5120 |
|
156 |
146 |
$98K |
| D1110 |
Prophylaxis - adult |
2,940 |
2,847 |
$98K |
| D0210 |
Intraoral - complete series of radiographic images |
2,098 |
1,677 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,534 |
2,278 |
$60K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
942 |
646 |
$48K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
310 |
231 |
$38K |
| D0330 |
Panoramic radiographic image |
905 |
696 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,451 |
1,248 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,501 |
2,178 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
2,320 |
2,255 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
3,956 |
3,486 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,842 |
1,780 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,322 |
1,287 |
$21K |
| D2160 |
|
342 |
255 |
$20K |
| D1120 |
Prophylaxis - child |
436 |
433 |
$13K |
| D2140 |
|
356 |
247 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
39 |
37 |
$12K |
| D2950 |
|
214 |
190 |
$11K |
| D4355 |
|
41 |
41 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
150 |
91 |
$2K |
| D2330 |
|
20 |
16 |
$2K |
| D3310 |
|
17 |
14 |
$449.92 |
| D2335 |
|
20 |
13 |
$291.99 |
| D2161 |
|
13 |
12 |
$194.66 |