| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
16,891 |
6,971 |
$1.60M |
| D0120 |
Periodic oral evaluation - established patient |
27,098 |
26,818 |
$1.14M |
| D0330 |
Panoramic radiographic image |
14,260 |
14,028 |
$1.13M |
| D1110 |
Prophylaxis - adult |
18,103 |
17,912 |
$1.09M |
| D1206 |
Topical application of fluoride varnish |
28,303 |
27,976 |
$896K |
| D0274 |
Bitewings - four radiographic images |
19,277 |
19,040 |
$878K |
| D1120 |
Prophylaxis - child |
14,903 |
14,733 |
$624K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,985 |
10,817 |
$486K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,600 |
4,211 |
$485K |
| D0140 |
Limited oral evaluation - problem focused |
12,447 |
11,389 |
$479K |
| D2140 |
|
5,450 |
3,526 |
$377K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,276 |
2,289 |
$331K |
| D5110 |
|
252 |
247 |
$308K |
| D1351 |
Sealant - per tooth |
7,995 |
2,936 |
$292K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,888 |
2,791 |
$274K |
| D0272 |
Bitewings - two radiographic images |
5,316 |
5,249 |
$183K |
| D0220 |
Intraoral - periapical first radiographic image |
10,568 |
10,179 |
$182K |
| D2160 |
|
1,690 |
1,435 |
$177K |
| D1330 |
|
3,589 |
3,467 |
$137K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
764 |
600 |
$108K |
| D2331 |
|
1,222 |
803 |
$103K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,971 |
3,711 |
$93K |
| D2335 |
|
599 |
501 |
$78K |
| D1354 |
|
1,571 |
444 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,212 |
2,904 |
$60K |
| D5120 |
|
41 |
41 |
$59K |
| D2330 |
|
867 |
588 |
$55K |
| D1310 |
|
1,178 |
1,175 |
$43K |
| D4341 |
|
107 |
53 |
$30K |
| D2332 |
|
291 |
219 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
210 |
194 |
$21K |
| D4910 |
|
83 |
82 |
$8K |
| D5410 |
|
311 |
271 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
95 |
95 |
$5K |
| D4355 |
|
70 |
70 |
$5K |
| D0273 |
|
55 |
53 |
$3K |
| D5411 |
|
86 |
82 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
414 |
407 |
$3K |
| D1320 |
|
61 |
61 |
$2K |
| D0270 |
|
91 |
89 |
$1K |
| D9110 |
|
117 |
107 |
$1K |
| D1999 |
|
11,429 |
9,257 |
$698.92 |
| D0603 |
|
17 |
17 |
$0.00 |