| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
12,490 |
2,926 |
$746K |
| D5110 |
|
775 |
739 |
$295K |
| D0330 |
Panoramic radiographic image |
5,679 |
5,504 |
$236K |
| D5120 |
|
500 |
471 |
$188K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
459 |
418 |
$175K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,142 |
5,986 |
$158K |
| D1110 |
Prophylaxis - adult |
3,976 |
3,878 |
$133K |
| D5214 |
|
240 |
235 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,080 |
1,265 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,449 |
908 |
$89K |
| D7310 |
|
699 |
339 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,776 |
2,690 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
871 |
317 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
1,209 |
1,164 |
$46K |
| D3320 |
|
147 |
128 |
$43K |
| D0274 |
Bitewings - four radiographic images |
2,397 |
2,348 |
$35K |
| D5213 |
|
63 |
61 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
649 |
385 |
$32K |
| D2332 |
|
458 |
248 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
502 |
342 |
$27K |
| D2335 |
|
310 |
184 |
$27K |
| D2160 |
|
394 |
265 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,692 |
2,634 |
$22K |
| D2394 |
|
270 |
198 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
4,249 |
4,034 |
$19K |
| D7230 |
|
96 |
48 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
688 |
677 |
$10K |
| D3310 |
|
39 |
24 |
$9K |
| D2331 |
|
159 |
109 |
$8K |
| D2330 |
|
159 |
89 |
$8K |
| D1120 |
Prophylaxis - child |
286 |
282 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
760 |
648 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
258 |
246 |
$3K |
| D2140 |
|
78 |
47 |
$3K |
| D2161 |
|
40 |
33 |
$3K |
| D5640 |
|
25 |
12 |
$2K |
| D5512 |
|
14 |
12 |
$840.00 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$225.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29 |
29 |
$125.00 |
| D1999 |
|
144 |
135 |
$0.00 |