| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
75,720 |
25,604 |
$4.47M |
| D1110 |
Prophylaxis - adult |
99,363 |
99,125 |
$4.16M |
| D5110 |
|
4,534 |
4,520 |
$2.75M |
| D1351 |
Sealant - per tooth |
91,376 |
18,616 |
$2.73M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
38,371 |
23,671 |
$2.62M |
| D0120 |
Periodic oral evaluation - established patient |
102,552 |
102,404 |
$2.48M |
| D1120 |
Prophylaxis - child |
49,789 |
49,782 |
$2.00M |
| D0210 |
Intraoral - complete series of radiographic images |
31,968 |
31,775 |
$1.88M |
| D5120 |
|
3,086 |
3,076 |
$1.86M |
| D1206 |
Topical application of fluoride varnish |
65,075 |
65,012 |
$1.66M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,689 |
3,552 |
$1.59M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,588 |
10,350 |
$1.53M |
| D2160 |
|
19,294 |
13,605 |
$1.52M |
| D2740 |
Crown - porcelain/ceramic |
2,346 |
1,791 |
$1.44M |
| D5214 |
|
1,966 |
1,941 |
$1.37M |
| D2331 |
|
17,461 |
10,908 |
$1.32M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17,881 |
12,011 |
$1.31M |
| D0274 |
Bitewings - four radiographic images |
42,594 |
42,506 |
$1.22M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
34,806 |
34,725 |
$1.21M |
| D0220 |
Intraoral - periapical first radiographic image |
91,578 |
90,436 |
$1.20M |
| D2335 |
|
9,507 |
6,332 |
$1.16M |
| D0230 |
Intraoral - periapical each additional radiographic image |
143,430 |
70,228 |
$1.12M |
| D2332 |
|
10,694 |
7,345 |
$1.03M |
| D2140 |
|
21,090 |
13,238 |
$1.02M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
10,795 |
5,959 |
$1.00M |
| D2330 |
|
16,488 |
9,364 |
$947K |
| D0140 |
Limited oral evaluation - problem focused |
27,621 |
27,198 |
$898K |
| D5213 |
|
1,273 |
1,258 |
$876K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,190 |
5,075 |
$771K |
| D4355 |
|
6,548 |
6,534 |
$508K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,606 |
2,186 |
$431K |
| D0330 |
Panoramic radiographic image |
7,433 |
7,420 |
$372K |
| D2950 |
|
2,436 |
2,031 |
$371K |
| D2161 |
|
4,044 |
3,450 |
$354K |
| D0272 |
Bitewings - two radiographic images |
14,024 |
14,012 |
$325K |
| D2791 |
|
465 |
422 |
$265K |
| D2394 |
|
1,515 |
1,340 |
$213K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,737 |
4,731 |
$138K |
| D9420 |
|
755 |
750 |
$125K |
| D3310 |
|
298 |
254 |
$119K |
| D3320 |
|
247 |
237 |
$115K |
| D5225 |
|
102 |
102 |
$85K |
| D0190 |
|
4,128 |
4,127 |
$61K |
| D5650 |
|
656 |
436 |
$57K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
86 |
82 |
$51K |
| D1354 |
|
1,742 |
758 |
$44K |
| D7310 |
|
400 |
220 |
$43K |
| D4341 |
|
338 |
110 |
$37K |
| D5750 |
|
248 |
241 |
$36K |
| D0273 |
|
1,372 |
1,372 |
$28K |
| D2710 |
|
43 |
37 |
$26K |
| D5226 |
|
31 |
31 |
$25K |
| D2940 |
|
393 |
359 |
$22K |
| D5422 |
|
520 |
505 |
$21K |
| D5410 |
|
537 |
516 |
$21K |
| D9930 |
|
627 |
566 |
$17K |
| D0191 |
|
792 |
792 |
$17K |
| D5411 |
|
424 |
416 |
$17K |
| D5751 |
|
103 |
101 |
$15K |
| D4910 |
|
164 |
164 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
27 |
$14K |
| D5421 |
|
260 |
251 |
$10K |
| D7230 |
|
36 |
27 |
$7K |
| D2954 |
|
34 |
27 |
$6K |
| D7220 |
|
18 |
13 |
$2K |
| D2920 |
|
25 |
25 |
$1K |
| D2951 |
|
38 |
36 |
$937.33 |
| D0270 |
|
92 |
92 |
$890.32 |
| D9995 |
|
139 |
136 |
$0.00 |
| D0603 |
|
12 |
12 |
$0.00 |
| D9987 |
|
13 |
13 |
$0.00 |
| D9986 |
|
45 |
44 |
$0.00 |