| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,747 |
1,451 |
$203K |
| D1110 |
Prophylaxis - adult |
4,894 |
4,835 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,971 |
1,662 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
5,660 |
5,578 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,690 |
1,389 |
$78K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
936 |
633 |
$73K |
| D1120 |
Prophylaxis - child |
2,342 |
2,316 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,383 |
3,337 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,552 |
2,511 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
1,749 |
1,723 |
$60K |
| D1206 |
Topical application of fluoride varnish |
3,908 |
3,860 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
2,069 |
2,007 |
$56K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
286 |
145 |
$45K |
| D0330 |
Panoramic radiographic image |
1,348 |
1,326 |
$41K |
| D1351 |
Sealant - per tooth |
956 |
452 |
$38K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
110 |
74 |
$32K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
86 |
83 |
$31K |
| D4341 |
|
699 |
459 |
$26K |
| D2331 |
|
460 |
378 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
3,114 |
2,987 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
326 |
296 |
$20K |
| D9920 |
|
224 |
219 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
463 |
429 |
$18K |
| D8670 |
Periodic orthodontic treatment visit |
480 |
478 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,033 |
1,024 |
$16K |
| D2330 |
|
280 |
221 |
$15K |
| D0190 |
|
599 |
592 |
$9K |
| D2332 |
|
130 |
116 |
$9K |
| D8660 |
|
154 |
152 |
$8K |
| D9243 |
|
18 |
14 |
$8K |
| D4910 |
|
257 |
252 |
$8K |
| D2335 |
|
91 |
76 |
$7K |
| D1330 |
|
2,070 |
2,037 |
$7K |
| D0603 |
|
828 |
816 |
$6K |
| D1354 |
|
477 |
327 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
443 |
367 |
$4K |
| D9239 |
|
14 |
14 |
$3K |
| D0602 |
|
372 |
366 |
$2K |
| D1320 |
|
132 |
131 |
$2K |
| D0270 |
|
120 |
118 |
$962.35 |
| D0601 |
|
111 |
109 |
$680.00 |
| D4342 |
|
42 |
31 |
$660.00 |
| D0240 |
|
14 |
14 |
$168.00 |
| D9310 |
|
175 |
172 |
$60.00 |