| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
13,404 |
7,066 |
$1.01M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,470 |
3,663 |
$351K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,191 |
8,153 |
$307K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,009 |
3,144 |
$258K |
| D2740 |
Crown - porcelain/ceramic |
531 |
417 |
$235K |
| D0120 |
Periodic oral evaluation - established patient |
8,833 |
8,171 |
$233K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,660 |
1,124 |
$227K |
| D0330 |
Panoramic radiographic image |
5,876 |
5,480 |
$222K |
| D1120 |
Prophylaxis - child |
7,011 |
6,510 |
$218K |
| D0140 |
Limited oral evaluation - problem focused |
7,421 |
6,864 |
$176K |
| D1206 |
Topical application of fluoride varnish |
5,822 |
5,419 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,918 |
5,490 |
$150K |
| D4341 |
|
1,438 |
1,026 |
$145K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
312 |
284 |
$128K |
| D1110 |
Prophylaxis - adult |
2,632 |
2,449 |
$123K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,310 |
1,152 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
3,502 |
3,235 |
$116K |
| D3310 |
|
458 |
409 |
$115K |
| D0220 |
Intraoral - periapical first radiographic image |
9,332 |
8,428 |
$100K |
| D0274 |
Bitewings - four radiographic images |
4,231 |
3,917 |
$91K |
| D5110 |
|
175 |
169 |
$79K |
| D1351 |
Sealant - per tooth |
1,362 |
811 |
$71K |
| D2331 |
|
1,002 |
813 |
$71K |
| D2330 |
|
1,111 |
809 |
$68K |
| D2950 |
|
525 |
459 |
$63K |
| D2335 |
|
538 |
399 |
$56K |
| D4910 |
|
777 |
730 |
$51K |
| D0272 |
Bitewings - two radiographic images |
3,217 |
2,974 |
$42K |
| D4342 |
|
378 |
264 |
$31K |
| D5120 |
|
76 |
74 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,418 |
2,817 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
356 |
231 |
$29K |
| D0270 |
|
2,606 |
2,427 |
$25K |
| D2332 |
|
267 |
212 |
$23K |
| D1354 |
|
492 |
299 |
$15K |
| D9630 |
|
823 |
753 |
$14K |
| D2954 |
|
27 |
25 |
$4K |
| D2394 |
|
13 |
12 |
$3K |
| D2160 |
|
42 |
30 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
48 |
41 |
$2K |
| D0603 |
|
299 |
278 |
$2.25 |
| D0602 |
|
19 |
19 |
$0.00 |