| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
33,235 |
9,563 |
$1.97M |
| D0140 |
Limited oral evaluation - problem focused |
18,514 |
15,580 |
$578K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,015 |
814 |
$483K |
| D0330 |
Panoramic radiographic image |
6,456 |
5,441 |
$295K |
| D7240 |
Removal of impacted tooth - completely bony |
1,437 |
392 |
$290K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,512 |
473 |
$239K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,075 |
1,251 |
$193K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,737 |
1,413 |
$189K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,916 |
703 |
$168K |
| D0220 |
Intraoral - periapical first radiographic image |
9,269 |
7,701 |
$124K |
| D1120 |
Prophylaxis - child |
3,998 |
3,311 |
$122K |
| D2950 |
|
943 |
697 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,098 |
3,409 |
$109K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,867 |
2,241 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
4,346 |
3,665 |
$98K |
| D1110 |
Prophylaxis - adult |
2,074 |
1,791 |
$90K |
| D1206 |
Topical application of fluoride varnish |
4,531 |
3,809 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
966 |
823 |
$61K |
| D2330 |
|
755 |
384 |
$50K |
| D9239 |
|
444 |
355 |
$49K |
| D3310 |
|
147 |
96 |
$48K |
| D8090 |
|
19 |
13 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,286 |
1,114 |
$42K |
| D2331 |
|
568 |
288 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,843 |
1,539 |
$39K |
| D3320 |
|
97 |
74 |
$32K |
| D1351 |
Sealant - per tooth |
1,305 |
416 |
$31K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
377 |
144 |
$29K |
| D0474 |
|
649 |
487 |
$29K |
| D8680 |
|
169 |
64 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
230 |
163 |
$27K |
| D9310 |
|
574 |
532 |
$26K |
| D9243 |
|
1,201 |
354 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
764 |
635 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,930 |
1,169 |
$14K |
| D0340 |
|
254 |
213 |
$14K |
| D2940 |
|
225 |
129 |
$11K |
| D0180 |
|
376 |
312 |
$10K |
| D2335 |
|
75 |
51 |
$9K |
| D0470 |
|
272 |
225 |
$9K |
| D9222 |
|
67 |
67 |
$8K |
| D2332 |
|
103 |
52 |
$8K |
| D9420 |
|
231 |
192 |
$7K |
| D0270 |
|
404 |
365 |
$7K |
| D0350 |
|
271 |
222 |
$5K |
| D5110 |
|
14 |
13 |
$4K |
| D1354 |
|
131 |
54 |
$4K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
119 |
54 |
$3K |
| D1999 |
|
4,160 |
2,443 |
$0.00 |
| D0191 |
|
345 |
315 |
$0.00 |
| D0380 |
|
86 |
69 |
$0.00 |