| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,376 |
10,264 |
$663K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,039 |
3,699 |
$593K |
| D0330 |
Panoramic radiographic image |
6,333 |
6,264 |
$550K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,960 |
2,154 |
$530K |
| D1206 |
Topical application of fluoride varnish |
14,906 |
14,766 |
$499K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,960 |
3,268 |
$443K |
| D0274 |
Bitewings - four radiographic images |
9,936 |
9,830 |
$435K |
| D4341 |
|
1,859 |
581 |
$382K |
| D0120 |
Periodic oral evaluation - established patient |
9,728 |
9,642 |
$367K |
| D0140 |
Limited oral evaluation - problem focused |
7,951 |
7,597 |
$337K |
| D1351 |
Sealant - per tooth |
8,306 |
1,857 |
$335K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,740 |
8,636 |
$272K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,438 |
5,380 |
$254K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,106 |
1,626 |
$254K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,690 |
908 |
$251K |
| D1330 |
|
6,931 |
6,860 |
$247K |
| D0220 |
Intraoral - periapical first radiographic image |
13,098 |
12,722 |
$225K |
| D1120 |
Prophylaxis - child |
4,653 |
4,620 |
$207K |
| D2331 |
|
1,320 |
735 |
$149K |
| D2335 |
|
997 |
744 |
$146K |
| D5212 |
|
143 |
140 |
$131K |
| D2332 |
|
822 |
556 |
$115K |
| D0272 |
Bitewings - two radiographic images |
2,886 |
2,862 |
$114K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,036 |
728 |
$111K |
| D0240 |
|
2,913 |
1,365 |
$109K |
| D5110 |
|
97 |
95 |
$108K |
| D2330 |
|
1,240 |
797 |
$108K |
| D9243 |
|
667 |
213 |
$78K |
| D2160 |
|
562 |
426 |
$73K |
| D6740 |
|
58 |
24 |
$61K |
| D5120 |
|
51 |
51 |
$60K |
| D6245 |
|
42 |
24 |
$45K |
| D2140 |
|
537 |
336 |
$45K |
| D7240 |
Removal of impacted tooth - completely bony |
136 |
57 |
$44K |
| D2394 |
|
273 |
230 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,507 |
1,420 |
$34K |
| D9239 |
|
213 |
211 |
$27K |
| D4910 |
|
280 |
274 |
$23K |
| D5211 |
|
26 |
26 |
$21K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
29 |
27 |
$18K |
| D2161 |
|
113 |
97 |
$18K |
| D3320 |
|
26 |
26 |
$13K |
| D9110 |
|
267 |
251 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
136 |
136 |
$8K |
| D2950 |
|
39 |
25 |
$8K |
| D9310 |
|
83 |
83 |
$5K |
| D7230 |
|
15 |
12 |
$4K |
| D4355 |
|
26 |
26 |
$1K |
| D9612 |
|
49 |
49 |
$1K |