| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
16,567 |
6,853 |
$674K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,092 |
2,902 |
$310K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,307 |
4,238 |
$266K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,586 |
3,782 |
$256K |
| D1110 |
Prophylaxis - adult |
7,773 |
7,758 |
$249K |
| D0210 |
Intraoral - complete series of radiographic images |
6,111 |
6,089 |
$214K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,556 |
8,538 |
$191K |
| D1351 |
Sealant - per tooth |
8,121 |
2,192 |
$179K |
| D1120 |
Prophylaxis - child |
4,591 |
4,587 |
$156K |
| D2331 |
|
2,613 |
1,961 |
$136K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
411 |
398 |
$135K |
| D0330 |
Panoramic radiographic image |
4,092 |
4,078 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
6,416 |
6,404 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
7,227 |
7,118 |
$105K |
| D1206 |
Topical application of fluoride varnish |
7,879 |
7,864 |
$99K |
| D0274 |
Bitewings - four radiographic images |
4,047 |
4,038 |
$86K |
| D4341 |
|
1,139 |
591 |
$86K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,286 |
1,164 |
$84K |
| D9310 |
|
2,025 |
2,015 |
$74K |
| D7230 |
|
534 |
369 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
8,257 |
8,089 |
$70K |
| D2330 |
|
1,573 |
1,161 |
$65K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,479 |
1,251 |
$60K |
| D2950 |
|
537 |
480 |
$53K |
| D4910 |
|
1,154 |
1,154 |
$45K |
| D5110 |
|
98 |
98 |
$38K |
| D4342 |
|
670 |
395 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,776 |
1,772 |
$29K |
| D3320 |
|
116 |
109 |
$24K |
| D2332 |
|
303 |
252 |
$20K |
| D2740 |
Crown - porcelain/ceramic |
82 |
73 |
$20K |
| D2160 |
|
388 |
342 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,341 |
2,974 |
$19K |
| D2335 |
|
202 |
173 |
$17K |
| D2140 |
|
642 |
482 |
$16K |
| D7250 |
|
463 |
256 |
$13K |
| D5214 |
|
28 |
27 |
$13K |
| D2940 |
|
503 |
463 |
$12K |
| D0240 |
|
561 |
351 |
$10K |
| D9239 |
|
52 |
51 |
$3K |
| D3310 |
|
26 |
24 |
$3K |
| D0270 |
|
329 |
327 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
18 |
18 |
$396.00 |
| D3221 |
|
27 |
27 |
$160.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
173 |
170 |
$0.00 |