| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
43,191 |
12,209 |
$1.95M |
| D5110 |
|
2,292 |
2,292 |
$1.25M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15,269 |
9,087 |
$1.02M |
| D5120 |
|
1,513 |
1,512 |
$817K |
| D1110 |
Prophylaxis - adult |
19,465 |
19,435 |
$743K |
| D0120 |
Periodic oral evaluation - established patient |
33,063 |
33,036 |
$736K |
| D2740 |
Crown - porcelain/ceramic |
1,088 |
732 |
$661K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,019 |
893 |
$578K |
| D2140 |
|
10,991 |
6,591 |
$573K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,007 |
3,089 |
$549K |
| D0210 |
Intraoral - complete series of radiographic images |
9,866 |
9,819 |
$481K |
| D3320 |
|
1,109 |
944 |
$472K |
| D3310 |
|
1,259 |
832 |
$470K |
| D2160 |
|
5,825 |
4,101 |
$440K |
| D1120 |
Prophylaxis - child |
10,746 |
10,746 |
$428K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,773 |
3,585 |
$396K |
| D5214 |
|
512 |
512 |
$386K |
| D2331 |
|
5,394 |
3,375 |
$384K |
| D2332 |
|
4,191 |
2,682 |
$370K |
| D5213 |
|
507 |
507 |
$354K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,976 |
10,957 |
$351K |
| D0330 |
Panoramic radiographic image |
9,393 |
9,388 |
$324K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,431 |
2,437 |
$324K |
| D2330 |
|
5,701 |
3,366 |
$324K |
| D0220 |
Intraoral - periapical first radiographic image |
23,624 |
23,511 |
$275K |
| D0274 |
Bitewings - four radiographic images |
10,977 |
10,963 |
$275K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,764 |
11,764 |
$273K |
| D2335 |
|
2,258 |
1,672 |
$249K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,394 |
20,795 |
$184K |
| D7310 |
|
1,368 |
689 |
$149K |
| D0272 |
Bitewings - two radiographic images |
6,506 |
6,505 |
$139K |
| D2950 |
|
817 |
637 |
$133K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
930 |
787 |
$108K |
| D5225 |
|
163 |
163 |
$97K |
| D7111 |
|
1,000 |
667 |
$66K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
326 |
263 |
$37K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
205 |
169 |
$36K |
| D2954 |
|
139 |
117 |
$26K |
| D5226 |
|
26 |
26 |
$16K |
| D2161 |
|
169 |
151 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
358 |
358 |
$10K |
| D5750 |
|
65 |
65 |
$9K |
| D2394 |
|
22 |
20 |
$2K |
| D5650 |
|
24 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
59 |
52 |
$805.50 |