| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
16,159 |
5,382 |
$990K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,368 |
1,227 |
$576K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,826 |
14,319 |
$398K |
| D0330 |
Panoramic radiographic image |
6,126 |
5,847 |
$264K |
| D0140 |
Limited oral evaluation - problem focused |
10,665 |
10,088 |
$263K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,152 |
3,034 |
$262K |
| D1120 |
Prophylaxis - child |
13,349 |
12,923 |
$258K |
| D1110 |
Prophylaxis - adult |
7,401 |
7,014 |
$258K |
| D0210 |
Intraoral - complete series of radiographic images |
4,315 |
4,079 |
$236K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,999 |
2,554 |
$224K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,198 |
1,351 |
$212K |
| D1351 |
Sealant - per tooth |
9,055 |
2,569 |
$201K |
| D1206 |
Topical application of fluoride varnish |
13,125 |
12,763 |
$196K |
| D0120 |
Periodic oral evaluation - established patient |
8,701 |
8,321 |
$154K |
| D7240 |
Removal of impacted tooth - completely bony |
830 |
342 |
$146K |
| D9222 |
|
1,411 |
1,327 |
$145K |
| D2740 |
Crown - porcelain/ceramic |
221 |
153 |
$105K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,307 |
547 |
$83K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
972 |
821 |
$79K |
| D0274 |
Bitewings - four radiographic images |
3,700 |
3,554 |
$75K |
| D3320 |
|
128 |
119 |
$61K |
| D0367 |
|
598 |
576 |
$60K |
| D4341 |
|
526 |
229 |
$52K |
| D2331 |
|
688 |
453 |
$47K |
| D2330 |
|
738 |
437 |
$42K |
| D7230 |
|
216 |
110 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
5,177 |
4,837 |
$31K |
| D2950 |
|
257 |
215 |
$26K |
| D4342 |
|
350 |
160 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,756 |
1,649 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,762 |
1,697 |
$19K |
| D9612 |
|
414 |
395 |
$17K |
| D8030 |
|
201 |
161 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,796 |
1,081 |
$12K |
| D5110 |
|
35 |
34 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
86 |
65 |
$8K |
| D3310 |
|
35 |
25 |
$7K |
| D5214 |
|
13 |
12 |
$6K |
| D5120 |
|
14 |
14 |
$6K |
| D0180 |
|
94 |
89 |
$4K |
| D4910 |
|
54 |
51 |
$4K |
| D2332 |
|
36 |
26 |
$3K |
| D2394 |
|
16 |
13 |
$2K |
| D0270 |
|
369 |
357 |
$2K |
| D2335 |
|
20 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
50 |
47 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
13 |
$756.00 |