| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,165 |
1,753 |
$226K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,841 |
2,223 |
$120K |
| D1120 |
Prophylaxis - child |
4,780 |
4,775 |
$109K |
| D0140 |
Limited oral evaluation - problem focused |
4,306 |
4,198 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,452 |
3,444 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
7,000 |
6,986 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,715 |
1,998 |
$85K |
| D1110 |
Prophylaxis - adult |
3,110 |
3,098 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
2,244 |
2,240 |
$68K |
| D1351 |
Sealant - per tooth |
4,164 |
1,332 |
$50K |
| D1206 |
Topical application of fluoride varnish |
5,088 |
5,078 |
$49K |
| D4910 |
|
1,796 |
1,794 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,757 |
2,456 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,648 |
3,537 |
$30K |
| D2331 |
|
699 |
499 |
$27K |
| D0274 |
Bitewings - four radiographic images |
2,388 |
2,383 |
$26K |
| D0272 |
Bitewings - two radiographic images |
3,064 |
3,060 |
$23K |
| D0240 |
|
1,909 |
1,063 |
$21K |
| D4342 |
|
485 |
272 |
$21K |
| D2330 |
|
512 |
367 |
$17K |
| D0330 |
Panoramic radiographic image |
1,536 |
1,531 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,564 |
1,435 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
214 |
193 |
$10K |
| D0270 |
|
1,228 |
1,216 |
$10K |
| D1354 |
|
1,860 |
620 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
46 |
37 |
$4K |
| D0180 |
|
133 |
132 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
47 |
26 |
$2K |
| D9248 |
|
12 |
12 |
$1K |
| D4341 |
|
20 |
13 |
$1K |
| D2940 |
|
32 |
27 |
$560.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
12 |
12 |
$462.00 |
| D0191 |
|
191 |
187 |
$0.00 |