| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
310,479 |
84,234 |
$17.25M |
| D1110 |
Prophylaxis - adult |
273,214 |
272,566 |
$11.23M |
| D5110 |
|
18,364 |
18,273 |
$10.84M |
| D5120 |
|
14,102 |
14,033 |
$8.26M |
| D0210 |
Intraoral - complete series of radiographic images |
127,594 |
126,691 |
$7.16M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
102,195 |
61,284 |
$6.58M |
| D0120 |
Periodic oral evaluation - established patient |
253,109 |
252,643 |
$5.97M |
| D1351 |
Sealant - per tooth |
195,711 |
38,336 |
$5.83M |
| D1120 |
Prophylaxis - child |
116,850 |
116,693 |
$4.65M |
| D2160 |
|
60,527 |
39,202 |
$4.54M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41,858 |
28,801 |
$4.34M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
125,666 |
125,291 |
$4.22M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
39,825 |
23,919 |
$3.70M |
| D1206 |
Topical application of fluoride varnish |
140,332 |
140,151 |
$3.50M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48,875 |
31,743 |
$3.50M |
| D5214 |
|
5,152 |
5,102 |
$3.45M |
| D0274 |
Bitewings - four radiographic images |
116,308 |
116,047 |
$3.23M |
| D2331 |
|
37,945 |
24,747 |
$2.78M |
| D0140 |
Limited oral evaluation - problem focused |
87,723 |
86,701 |
$2.75M |
| D4355 |
|
35,482 |
35,364 |
$2.75M |
| D2335 |
|
21,524 |
14,243 |
$2.45M |
| D0220 |
Intraoral - periapical first radiographic image |
194,644 |
192,619 |
$2.43M |
| D2740 |
Crown - porcelain/ceramic |
4,124 |
3,409 |
$2.42M |
| D5213 |
|
3,621 |
3,585 |
$2.41M |
| D2332 |
|
25,858 |
17,230 |
$2.36M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19,242 |
15,388 |
$2.32M |
| D2140 |
|
46,449 |
30,646 |
$2.31M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,805 |
4,174 |
$1.99M |
| D0230 |
Intraoral - periapical each additional radiographic image |
262,946 |
138,943 |
$1.96M |
| D2330 |
|
30,496 |
19,700 |
$1.79M |
| D1354 |
|
63,726 |
22,970 |
$1.35M |
| D7310 |
|
11,879 |
5,604 |
$1.27M |
| D2161 |
|
11,094 |
9,318 |
$935K |
| D2950 |
|
6,147 |
5,297 |
$909K |
| D2394 |
|
6,229 |
5,486 |
$807K |
| D4341 |
|
5,763 |
2,557 |
$744K |
| D5225 |
|
1,386 |
1,376 |
$694K |
| D0330 |
Panoramic radiographic image |
16,320 |
16,275 |
$691K |
| D0272 |
Bitewings - two radiographic images |
27,460 |
27,424 |
$627K |
| D5750 |
|
3,519 |
3,510 |
$612K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
5,303 |
2,132 |
$598K |
| D2791 |
|
995 |
941 |
$585K |
| D5751 |
|
2,711 |
2,703 |
$472K |
| D0145 |
Oral evaluation for a patient under three years of age |
11,635 |
11,576 |
$328K |
| D2710 |
|
428 |
360 |
$247K |
| D5226 |
|
410 |
403 |
$193K |
| D9420 |
|
1,266 |
1,226 |
$189K |
| D5130 |
|
335 |
309 |
$185K |
| D7250 |
|
2,437 |
1,475 |
$172K |
| D4342 |
|
1,908 |
986 |
$170K |
| D5650 |
|
1,701 |
1,185 |
$153K |
| D4910 |
|
1,997 |
1,995 |
$150K |
| D3310 |
|
351 |
308 |
$139K |
| D7230 |
|
947 |
664 |
$131K |
| D3320 |
|
267 |
259 |
$123K |
| D5411 |
|
2,769 |
2,738 |
$117K |
| D5410 |
|
2,509 |
2,439 |
$107K |
| D7220 |
|
1,132 |
804 |
$102K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
196 |
180 |
$100K |
| D5212 |
|
164 |
163 |
$92K |
| D7320 |
|
663 |
416 |
$91K |
| D0240 |
|
3,734 |
2,033 |
$79K |
| D4346 |
|
1,173 |
1,170 |
$75K |
| D9930 |
|
2,502 |
2,301 |
$74K |
| D5422 |
|
1,557 |
1,533 |
$66K |
| D5211 |
|
87 |
87 |
$54K |
| D1510 |
|
264 |
221 |
$49K |
| D2940 |
|
818 |
745 |
$44K |
| D0273 |
|
2,029 |
2,026 |
$41K |
| D9310 |
|
1,180 |
1,179 |
$39K |
| D5421 |
|
840 |
826 |
$36K |
| D5140 |
|
45 |
41 |
$25K |
| D2920 |
|
503 |
484 |
$22K |
| D5520 |
|
280 |
201 |
$21K |
| D7473 |
|
111 |
90 |
$20K |
| D9243 |
|
306 |
208 |
$18K |
| D5512 |
|
186 |
186 |
$17K |
| D0270 |
|
1,762 |
1,747 |
$17K |
| D7240 |
Removal of impacted tooth - completely bony |
102 |
51 |
$15K |
| D9239 |
|
500 |
215 |
$15K |
| D2954 |
|
66 |
64 |
$10K |
| D5511 |
|
92 |
92 |
$9K |
| D7111 |
|
145 |
110 |
$9K |
| D5640 |
|
114 |
86 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
407 |
406 |
$6K |
| D7471 |
|
35 |
28 |
$5K |
| D5660 |
|
18 |
14 |
$2K |
| D9110 |
|
12 |
12 |
$419.00 |
| D2951 |
|
16 |
14 |
$411.11 |
| D0180 |
|
20 |
20 |
$0.00 |
| D0460 |
|
21 |
20 |
$0.00 |