| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
10,879 |
3,945 |
$574K |
| D0330 |
Panoramic radiographic image |
5,273 |
4,965 |
$219K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,571 |
2,444 |
$183K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,763 |
2,182 |
$183K |
| D1110 |
Prophylaxis - adult |
5,645 |
5,328 |
$180K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,298 |
6,850 |
$174K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
416 |
390 |
$148K |
| D0210 |
Intraoral - complete series of radiographic images |
2,721 |
2,189 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
3,627 |
3,343 |
$77K |
| D0274 |
Bitewings - four radiographic images |
4,332 |
4,138 |
$76K |
| D3320 |
|
227 |
210 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,002 |
790 |
$60K |
| D1120 |
Prophylaxis - child |
3,001 |
2,948 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
3,367 |
3,274 |
$56K |
| D3310 |
|
191 |
121 |
$44K |
| D2330 |
|
686 |
418 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
6,468 |
5,931 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,774 |
1,731 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,569 |
3,789 |
$24K |
| D2335 |
|
284 |
184 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,530 |
1,515 |
$23K |
| D2950 |
|
245 |
206 |
$18K |
| D2332 |
|
254 |
182 |
$18K |
| D1351 |
Sealant - per tooth |
767 |
215 |
$16K |
| D2331 |
|
289 |
202 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
140 |
91 |
$15K |
| D2394 |
|
177 |
153 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,308 |
1,275 |
$12K |
| D5110 |
|
66 |
30 |
$11K |
| D2140 |
|
188 |
104 |
$8K |
| D2954 |
|
61 |
41 |
$7K |
| D7240 |
Removal of impacted tooth - completely bony |
38 |
13 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
134 |
91 |
$7K |
| D5120 |
|
48 |
13 |
$5K |
| D7230 |
|
23 |
13 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
44 |
26 |
$2K |
| D2160 |
|
28 |
21 |
$2K |
| D0270 |
|
389 |
361 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
49 |
46 |
$1K |
| D2161 |
|
18 |
13 |
$1K |
| D0367 |
|
14 |
14 |
$1K |
| D4341 |
|
44 |
12 |
$1K |
| D0340 |
|
19 |
19 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
13 |
$1K |
| D0470 |
|
19 |
19 |
$439.28 |
| D1320 |
|
20 |
20 |
$255.00 |
| D0350 |
|
18 |
18 |
$232.74 |
| D1999 |
|
17 |
16 |
$0.00 |
| D1330 |
|
17 |
17 |
$0.00 |