| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,299 |
1,760 |
$324K |
| D1110 |
Prophylaxis - adult |
3,966 |
3,923 |
$139K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,760 |
1,158 |
$96K |
| D0274 |
Bitewings - four radiographic images |
3,052 |
3,005 |
$83K |
| D0330 |
Panoramic radiographic image |
2,276 |
2,238 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
3,209 |
3,194 |
$62K |
| D2160 |
|
903 |
703 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,405 |
2,366 |
$47K |
| D1351 |
Sealant - per tooth |
1,462 |
257 |
$38K |
| D2332 |
|
557 |
352 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
778 |
738 |
$36K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
78 |
72 |
$36K |
| D1120 |
Prophylaxis - child |
1,048 |
1,045 |
$32K |
| D2140 |
|
712 |
497 |
$32K |
| D2335 |
|
367 |
251 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,218 |
1,215 |
$24K |
| D5110 |
|
45 |
45 |
$22K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
56 |
37 |
$18K |
| D2330 |
|
227 |
153 |
$11K |
| D0272 |
Bitewings - two radiographic images |
553 |
548 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
955 |
928 |
$7K |
| D5214 |
|
13 |
12 |
$7K |
| D5120 |
|
13 |
13 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
31 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
63 |
$642.15 |
| D1330 |
|
12 |
12 |
$152.88 |
| D1310 |
|
12 |
12 |
$150.00 |