| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,696 |
2,408 |
$410K |
| D1110 |
Prophylaxis - adult |
6,454 |
5,788 |
$243K |
| D0120 |
Periodic oral evaluation - established patient |
11,682 |
10,520 |
$223K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,888 |
1,806 |
$159K |
| D1120 |
Prophylaxis - child |
6,615 |
5,988 |
$145K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,067 |
7,325 |
$136K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,511 |
863 |
$89K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
663 |
370 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,898 |
2,586 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,296 |
2,099 |
$65K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
912 |
435 |
$61K |
| D2140 |
|
1,387 |
949 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
2,082 |
1,874 |
$53K |
| D0330 |
Panoramic radiographic image |
946 |
871 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,910 |
2,658 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
4,891 |
4,289 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,760 |
2,684 |
$28K |
| D1354 |
|
1,240 |
434 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
272 |
176 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
263 |
247 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
232 |
152 |
$15K |
| D2331 |
|
116 |
52 |
$7K |
| D2160 |
|
86 |
64 |
$6K |
| D1351 |
Sealant - per tooth |
137 |
25 |
$3K |
| D2931 |
|
14 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
35 |
29 |
$1K |