| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,487 |
1,504 |
$197K |
| D1110 |
Prophylaxis - adult |
5,239 |
5,211 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
6,395 |
6,352 |
$124K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,270 |
1,877 |
$121K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,777 |
925 |
$111K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
348 |
330 |
$101K |
| D0274 |
Bitewings - four radiographic images |
3,394 |
3,355 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,992 |
1,492 |
$90K |
| D1120 |
Prophylaxis - child |
2,325 |
2,320 |
$66K |
| D1206 |
Topical application of fluoride varnish |
5,230 |
5,181 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,722 |
2,710 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,423 |
1,419 |
$63K |
| D1351 |
Sealant - per tooth |
2,468 |
728 |
$56K |
| D0330 |
Panoramic radiographic image |
1,458 |
1,456 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
2,507 |
2,436 |
$38K |
| D2331 |
|
635 |
504 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
500 |
461 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
3,745 |
3,618 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,322 |
1,314 |
$21K |
| D2330 |
|
472 |
351 |
$21K |
| D9920 |
|
157 |
153 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
969 |
935 |
$19K |
| D4341 |
|
1,312 |
854 |
$15K |
| D1354 |
|
1,191 |
490 |
$15K |
| D2335 |
|
210 |
162 |
$14K |
| D1330 |
|
1,810 |
1,803 |
$11K |
| D4910 |
|
381 |
371 |
$11K |
| D0603 |
|
945 |
944 |
$9K |
| D2332 |
|
153 |
123 |
$9K |
| D4342 |
|
696 |
611 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
40 |
14 |
$7K |
| D8670 |
Periodic orthodontic treatment visit |
64 |
64 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
525 |
467 |
$5K |
| D5214 |
|
14 |
12 |
$5K |
| D7240 |
Removal of impacted tooth - completely bony |
26 |
12 |
$5K |
| D3320 |
|
29 |
28 |
$3K |
| D7250 |
|
44 |
12 |
$3K |
| D3310 |
|
17 |
13 |
$2K |
| D1320 |
|
148 |
146 |
$2K |
| D0270 |
|
276 |
272 |
$2K |
| D0602 |
|
204 |
204 |
$2K |
| D0190 |
|
70 |
70 |
$1K |
| D8660 |
|
33 |
30 |
$1K |
| D0601 |
|
26 |
26 |
$240.00 |
| D9310 |
|
42 |
41 |
$25.00 |