| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
46,088 |
18,420 |
$2.78M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
536 |
425 |
$1.45M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,759 |
2,688 |
$1.33M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,937 |
5,764 |
$1.32M |
| D7240 |
Removal of impacted tooth - completely bony |
4,983 |
2,036 |
$1.18M |
| D1110 |
Prophylaxis - adult |
25,753 |
25,395 |
$1.09M |
| D0140 |
Limited oral evaluation - problem focused |
38,711 |
37,847 |
$1.03M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,629 |
7,514 |
$824K |
| D5110 |
|
1,262 |
1,174 |
$773K |
| D1351 |
Sealant - per tooth |
32,483 |
7,885 |
$764K |
| D0120 |
Periodic oral evaluation - established patient |
37,477 |
36,943 |
$750K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,030 |
8,289 |
$746K |
| D1120 |
Prophylaxis - child |
24,421 |
23,981 |
$737K |
| D0210 |
Intraoral - complete series of radiographic images |
13,842 |
13,304 |
$695K |
| D1206 |
Topical application of fluoride varnish |
39,131 |
38,514 |
$691K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,652 |
3,620 |
$653K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
7,210 |
4,009 |
$643K |
| D7230 |
|
2,960 |
1,526 |
$605K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20,197 |
19,849 |
$571K |
| D2740 |
Crown - porcelain/ceramic |
1,154 |
832 |
$510K |
| D9222 |
|
4,624 |
4,455 |
$444K |
| D5214 |
|
747 |
585 |
$401K |
| D5120 |
|
620 |
596 |
$393K |
| D2331 |
|
5,148 |
3,646 |
$382K |
| D4341 |
|
3,691 |
1,384 |
$321K |
| D0330 |
Panoramic radiographic image |
12,359 |
12,191 |
$318K |
| D2330 |
|
5,267 |
3,600 |
$315K |
| D3310 |
|
1,078 |
913 |
$315K |
| D3320 |
|
836 |
812 |
$301K |
| D0220 |
Intraoral - periapical first radiographic image |
24,223 |
23,655 |
$293K |
| D2950 |
|
2,268 |
2,034 |
$292K |
| D0274 |
Bitewings - four radiographic images |
9,927 |
9,814 |
$240K |
| D4910 |
|
3,282 |
3,263 |
$238K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,509 |
2,178 |
$234K |
| D2332 |
|
2,523 |
1,962 |
$220K |
| D0272 |
Bitewings - two radiographic images |
11,704 |
11,481 |
$191K |
| D2335 |
|
1,854 |
1,372 |
$182K |
| D9310 |
|
5,011 |
4,951 |
$158K |
| D5213 |
|
272 |
221 |
$147K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,898 |
1,491 |
$127K |
| D2752 |
|
390 |
257 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,859 |
6,722 |
$94K |
| D0364 |
|
2,197 |
2,163 |
$93K |
| D7310 |
|
777 |
355 |
$70K |
| D4342 |
|
1,855 |
780 |
$65K |
| D1354 |
|
11,998 |
4,828 |
$64K |
| D2940 |
|
1,742 |
1,202 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,390 |
4,355 |
$59K |
| D0340 |
|
695 |
689 |
$50K |
| D4346 |
|
915 |
912 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
951 |
867 |
$43K |
| D0470 |
|
745 |
739 |
$41K |
| D0240 |
|
2,403 |
2,157 |
$35K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,163 |
1,140 |
$34K |
| D0180 |
|
1,123 |
1,113 |
$30K |
| D7220 |
|
202 |
124 |
$29K |
| D0270 |
|
2,670 |
2,641 |
$26K |
| D9243 |
|
477 |
296 |
$26K |
| D1510 |
|
212 |
183 |
$22K |
| D9239 |
|
332 |
313 |
$22K |
| D2394 |
|
209 |
171 |
$19K |
| D9410 |
|
556 |
413 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
236 |
194 |
$13K |
| D3348 |
|
27 |
25 |
$11K |
| D9110 |
|
991 |
924 |
$11K |
| D0603 |
|
3,715 |
3,659 |
$10K |
| D0602 |
|
3,599 |
3,556 |
$10K |
| D1353 |
|
307 |
95 |
$9K |
| D8660 |
|
43 |
43 |
$7K |
| D2792 |
|
14 |
12 |
$6K |
| D9420 |
|
107 |
103 |
$6K |
| D0601 |
|
1,327 |
1,314 |
$3K |
| D2160 |
|
48 |
45 |
$3K |
| D3332 |
|
19 |
16 |
$3K |
| D2140 |
|
59 |
52 |
$2K |
| D0366 |
|
14 |
14 |
$2K |
| D9610 |
|
34 |
34 |
$1K |
| D0460 |
|
174 |
127 |
$953.18 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
12 |
12 |
$778.36 |
| D0350 |
|
528 |
523 |
$756.50 |
| D9995 |
|
94 |
93 |
$0.00 |
| D1330 |
|
17 |
16 |
$0.00 |