| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
18,378 |
12,840 |
$631K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,297 |
1,501 |
$443K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,609 |
6,967 |
$372K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,570 |
1,299 |
$279K |
| D1351 |
Sealant - per tooth |
8,748 |
1,111 |
$238K |
| D1110 |
Prophylaxis - adult |
4,076 |
3,624 |
$199K |
| D0330 |
Panoramic radiographic image |
3,569 |
3,122 |
$198K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,762 |
1,054 |
$175K |
| D0120 |
Periodic oral evaluation - established patient |
5,144 |
4,521 |
$122K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,565 |
2,337 |
$96K |
| D0220 |
Intraoral - periapical first radiographic image |
6,214 |
5,193 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,125 |
667 |
$89K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
814 |
593 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,044 |
3,429 |
$80K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
136 |
119 |
$79K |
| D1120 |
Prophylaxis - child |
2,113 |
1,773 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,129 |
1,839 |
$67K |
| D2950 |
|
374 |
310 |
$47K |
| D5110 |
|
75 |
57 |
$30K |
| D2740 |
Crown - porcelain/ceramic |
36 |
29 |
$21K |
| D2954 |
|
118 |
96 |
$18K |
| D2332 |
|
124 |
80 |
$12K |
| D3310 |
|
29 |
20 |
$11K |
| D1353 |
|
1,086 |
109 |
$11K |
| D2335 |
|
63 |
41 |
$10K |
| D0272 |
Bitewings - two radiographic images |
357 |
270 |
$8K |
| D3320 |
|
20 |
14 |
$7K |
| D4341 |
|
31 |
12 |
$4K |
| D5120 |
|
13 |
12 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
118 |
76 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$3K |
| D0470 |
|
98 |
83 |
$3K |
| D2330 |
|
22 |
15 |
$1K |
| D2940 |
|
32 |
28 |
$331.40 |
| D9211 |
|
16 |
12 |
$306.00 |
| D0350 |
|
16 |
12 |
$295.00 |