| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,788 |
3,838 |
$548K |
| D0120 |
Periodic oral evaluation - established patient |
16,292 |
16,145 |
$503K |
| D1110 |
Prophylaxis - adult |
10,906 |
10,815 |
$499K |
| D1206 |
Topical application of fluoride varnish |
19,759 |
19,594 |
$484K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,943 |
4,372 |
$414K |
| D1120 |
Prophylaxis - child |
11,062 |
10,962 |
$370K |
| D0330 |
Panoramic radiographic image |
4,460 |
4,418 |
$369K |
| D0274 |
Bitewings - four radiographic images |
9,994 |
9,924 |
$338K |
| D0220 |
Intraoral - periapical first radiographic image |
23,541 |
22,845 |
$327K |
| D0140 |
Limited oral evaluation - problem focused |
9,878 |
9,573 |
$303K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,826 |
16,095 |
$302K |
| D1330 |
|
10,142 |
10,009 |
$251K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,374 |
6,340 |
$221K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,156 |
2,777 |
$192K |
| D0272 |
Bitewings - two radiographic images |
5,789 |
5,745 |
$173K |
| D1351 |
Sealant - per tooth |
5,225 |
1,475 |
$129K |
| D0240 |
|
3,968 |
1,996 |
$112K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
835 |
581 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,797 |
2,487 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,022 |
789 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
654 |
459 |
$41K |
| D1354 |
|
1,271 |
395 |
$40K |
| D2331 |
|
680 |
495 |
$35K |
| D2160 |
|
352 |
291 |
$34K |
| D2335 |
|
397 |
297 |
$33K |
| D2330 |
|
418 |
293 |
$16K |
| D2140 |
|
169 |
119 |
$10K |
| D2332 |
|
179 |
138 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
63 |
40 |
$9K |
| D0180 |
|
73 |
73 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
174 |
172 |
$4K |
| D9110 |
|
15 |
15 |
$504.28 |
| D2394 |
|
101 |
87 |
$108.54 |
| D9985 |
|
17 |
13 |
$2.10 |
| D4355 |
|
19 |
19 |
$0.00 |