| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
8,255 |
2,736 |
$563K |
| D0120 |
Periodic oral evaluation - established patient |
21,755 |
20,273 |
$561K |
| D1110 |
Prophylaxis - adult |
11,553 |
10,810 |
$534K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,356 |
3,438 |
$500K |
| D0210 |
Intraoral - complete series of radiographic images |
5,256 |
4,878 |
$434K |
| D0272 |
Bitewings - two radiographic images |
18,424 |
17,381 |
$396K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,177 |
17,977 |
$374K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,003 |
8,959 |
$280K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,973 |
850 |
$270K |
| D1120 |
Prophylaxis - child |
7,656 |
7,173 |
$266K |
| D2160 |
|
2,785 |
1,372 |
$252K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,289 |
1,852 |
$249K |
| D2140 |
|
1,783 |
929 |
$111K |
| D0220 |
Intraoral - periapical first radiographic image |
6,127 |
5,387 |
$103K |
| D1351 |
Sealant - per tooth |
2,749 |
858 |
$75K |
| D4341 |
|
552 |
256 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
2,043 |
1,861 |
$66K |
| D2161 |
|
589 |
270 |
$65K |
| D0330 |
Panoramic radiographic image |
2,371 |
2,318 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,350 |
1,343 |
$45K |
| D0240 |
|
1,751 |
936 |
$43K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
77 |
67 |
$40K |
| D2931 |
|
217 |
182 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
382 |
236 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,520 |
1,345 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
245 |
150 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
95 |
52 |
$13K |
| D2394 |
|
67 |
41 |
$7K |
| D2332 |
|
64 |
25 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
69 |
36 |
$6K |