| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
12,768 |
4,931 |
$853K |
| D0120 |
Periodic oral evaluation - established patient |
15,390 |
12,965 |
$308K |
| D1120 |
Prophylaxis - child |
13,272 |
11,209 |
$303K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,286 |
1,041 |
$291K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,423 |
2,835 |
$282K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,369 |
2,728 |
$258K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,770 |
11,852 |
$218K |
| D1110 |
Prophylaxis - adult |
4,815 |
4,148 |
$188K |
| D1351 |
Sealant - per tooth |
6,882 |
2,824 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,319 |
4,604 |
$155K |
| D0140 |
Limited oral evaluation - problem focused |
4,239 |
3,461 |
$99K |
| D0272 |
Bitewings - two radiographic images |
8,477 |
7,124 |
$97K |
| D0274 |
Bitewings - four radiographic images |
3,903 |
3,300 |
$85K |
| D0330 |
Panoramic radiographic image |
1,619 |
1,383 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
12,600 |
10,366 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,821 |
4,454 |
$67K |
| D1354 |
|
3,648 |
1,378 |
$62K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,292 |
1,070 |
$62K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
717 |
504 |
$59K |
| D1206 |
Topical application of fluoride varnish |
2,131 |
1,592 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
841 |
694 |
$42K |
| D2330 |
|
605 |
352 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
507 |
400 |
$27K |
| D2331 |
|
301 |
195 |
$25K |
| D0240 |
|
1,761 |
848 |
$20K |
| D2140 |
|
401 |
307 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
151 |
112 |
$10K |
| D0270 |
|
1,258 |
1,070 |
$5K |
| D2332 |
|
16 |
14 |
$2K |
| D0603 |
|
201 |
165 |
$0.00 |
| D9248 |
|
50 |
40 |
$0.00 |