| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,113 |
690 |
$176K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
537 |
486 |
$83K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
109 |
107 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
1,249 |
1,240 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
948 |
869 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
494 |
427 |
$62K |
| D0330 |
Panoramic radiographic image |
619 |
618 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,185 |
1,185 |
$44K |
| D1120 |
Prophylaxis - child |
829 |
829 |
$42K |
| D2740 |
Crown - porcelain/ceramic |
49 |
47 |
$36K |
| D2950 |
|
166 |
159 |
$34K |
| D0274 |
Bitewings - four radiographic images |
606 |
606 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,291 |
1,271 |
$27K |
| D1206 |
Topical application of fluoride varnish |
724 |
724 |
$26K |
| D3310 |
|
48 |
45 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
142 |
133 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
405 |
405 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
262 |
262 |
$23K |
| D1110 |
Prophylaxis - adult |
289 |
289 |
$20K |
| D5110 |
|
19 |
19 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
39 |
29 |
$15K |
| D2331 |
|
105 |
90 |
$13K |
| D5120 |
|
12 |
12 |
$12K |
| D0272 |
Bitewings - two radiographic images |
337 |
337 |
$11K |
| D0270 |
|
467 |
467 |
$10K |
| D1351 |
Sealant - per tooth |
132 |
83 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
348 |
346 |
$8K |
| D2330 |
|
70 |
62 |
$8K |
| D4341 |
|
48 |
36 |
$7K |
| D4910 |
|
73 |
73 |
$6K |
| D2335 |
|
18 |
16 |
$4K |
| D2332 |
|
13 |
12 |
$2K |
| D9630 |
|
26 |
26 |
$608.50 |