| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
23,279 |
11,522 |
$1K |
| D1351 |
Sealant - per tooth |
29,068 |
8,487 |
$300.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,866 |
12,958 |
$277.00 |
| D0220 |
Intraoral - periapical first radiographic image |
125,367 |
113,039 |
$46.00 |
| D0270 |
|
13,604 |
13,017 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,291 |
4,976 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
89,525 |
86,803 |
$0.00 |
| D1110 |
Prophylaxis - adult |
83,619 |
81,486 |
$0.00 |
| D1120 |
Prophylaxis - child |
37,125 |
36,067 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,164 |
8,348 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
1,892 |
1,807 |
$0.00 |
| D2940 |
|
11,998 |
7,521 |
$0.00 |
| D1354 |
|
44,185 |
10,730 |
$0.00 |
| D5850 |
|
160 |
153 |
$0.00 |
| D0330 |
Panoramic radiographic image |
10,889 |
10,500 |
$0.00 |
| D0277 |
|
2,669 |
2,568 |
$0.00 |
| D4910 |
|
1,468 |
1,433 |
$0.00 |
| D4921 |
|
476 |
188 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,465 |
833 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,225 |
1,100 |
$0.00 |
| D5110 |
|
687 |
678 |
$0.00 |
| D2332 |
|
77 |
57 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
194 |
158 |
$0.00 |
| D5411 |
|
144 |
134 |
$0.00 |
| D4341 |
|
19 |
12 |
$0.00 |
| D9110 |
|
79 |
77 |
$0.00 |
| D0460 |
|
118 |
117 |
$0.00 |
| D0191 |
|
175 |
175 |
$0.00 |
| D5821 |
|
13 |
13 |
$0.00 |
| D8660 |
|
29 |
27 |
$0.00 |
| D3221 |
|
44 |
42 |
$0.00 |
| D2140 |
|
20 |
13 |
$0.00 |
| D0602 |
|
34,043 |
32,949 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
121,987 |
117,835 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
22,342 |
21,542 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
101,981 |
96,806 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
110,157 |
107,193 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
91,618 |
36,326 |
$0.00 |
| D0603 |
|
57,016 |
54,861 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
37,665 |
36,592 |
$0.00 |
| D0601 |
|
47,522 |
46,067 |
$0.00 |
| D1330 |
|
7,706 |
7,286 |
$0.00 |
| D2330 |
|
459 |
299 |
$0.00 |
| D4346 |
|
2,964 |
2,853 |
$0.00 |
| D0240 |
|
7,554 |
4,211 |
$0.00 |
| D0170 |
|
6,007 |
5,780 |
$0.00 |
| D9310 |
|
2,589 |
2,556 |
$0.00 |
| D0273 |
|
106 |
90 |
$0.00 |
| D2335 |
|
108 |
92 |
$0.00 |
| D4999 |
|
130 |
130 |
$0.00 |
| D2331 |
|
650 |
520 |
$0.00 |
| D1353 |
|
1,245 |
474 |
$0.00 |
| D1320 |
|
193 |
186 |
$0.00 |
| D3120 |
|
493 |
221 |
$0.00 |
| D7240 |
Removal of impacted tooth - completely bony |
157 |
98 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
465 |
415 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
114 |
112 |
$0.00 |
| D5851 |
|
137 |
129 |
$0.00 |
| D5120 |
|
235 |
233 |
$0.00 |
| D9420 |
|
547 |
539 |
$0.00 |
| D7230 |
|
169 |
129 |
$0.00 |
| D2390 |
|
142 |
48 |
$0.00 |
| D5410 |
|
106 |
101 |
$0.00 |
| D5750 |
|
55 |
54 |
$0.00 |
| D5130 |
|
39 |
39 |
$0.00 |
| D4355 |
|
12 |
12 |
$0.00 |
| D7220 |
|
17 |
12 |
$0.00 |
| D5730 |
|
12 |
12 |
$0.00 |