| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
14,249 |
5,985 |
$1.38M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,334 |
9,341 |
$1.25M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
415 |
386 |
$1.07M |
| D1110 |
Prophylaxis - adult |
17,136 |
16,910 |
$897K |
| D0120 |
Periodic oral evaluation - established patient |
27,263 |
26,913 |
$831K |
| D1120 |
Prophylaxis - child |
16,354 |
16,112 |
$559K |
| D0140 |
Limited oral evaluation - problem focused |
18,909 |
18,432 |
$559K |
| D1206 |
Topical application of fluoride varnish |
33,986 |
33,490 |
$541K |
| D0330 |
Panoramic radiographic image |
10,385 |
10,200 |
$540K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,867 |
5,243 |
$526K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,969 |
2,483 |
$459K |
| D0274 |
Bitewings - four radiographic images |
13,184 |
13,002 |
$397K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,713 |
5,587 |
$330K |
| D9243 |
|
1,899 |
1,460 |
$279K |
| D2740 |
Crown - porcelain/ceramic |
518 |
335 |
$252K |
| D0220 |
Intraoral - periapical first radiographic image |
18,453 |
18,056 |
$223K |
| D9239 |
|
1,549 |
1,508 |
$223K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,457 |
1,237 |
$184K |
| D0210 |
Intraoral - complete series of radiographic images |
1,794 |
1,775 |
$152K |
| D7240 |
Removal of impacted tooth - completely bony |
440 |
176 |
$83K |
| D1351 |
Sealant - per tooth |
5,001 |
1,330 |
$76K |
| D9450 |
|
556 |
545 |
$68K |
| D8660 |
|
1,974 |
1,943 |
$64K |
| D0272 |
Bitewings - two radiographic images |
3,292 |
3,255 |
$57K |
| D7230 |
|
253 |
163 |
$41K |
| D0470 |
|
843 |
831 |
$38K |
| D2950 |
|
257 |
236 |
$37K |
| D7111 |
|
537 |
338 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,320 |
1,183 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
941 |
885 |
$17K |
| D0340 |
|
275 |
275 |
$16K |
| D2710 |
|
48 |
40 |
$14K |
| D3120 |
|
396 |
358 |
$13K |
| D0270 |
|
650 |
643 |
$12K |
| D1330 |
|
952 |
878 |
$11K |
| D7310 |
|
29 |
15 |
$4K |
| D0190 |
|
146 |
144 |
$3K |
| D7311 |
|
29 |
25 |
$3K |
| D2940 |
|
95 |
64 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
148 |
134 |
$2K |
| D2335 |
|
16 |
12 |
$2K |
| D4355 |
|
14 |
13 |
$1K |
| D4910 |
|
12 |
12 |
$1K |
| D0180 |
|
12 |
12 |
$843.36 |
| D1208 |
Topical application of fluoride, excluding varnish |
60 |
58 |
$684.00 |
| D9310 |
|
12 |
12 |
$669.36 |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
12 |
12 |
$637.50 |
| D0460 |
|
14 |
13 |
$357.36 |