| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
34,886 |
10,275 |
$1.88M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
3,457 |
3,160 |
$1.38M |
| D8670 |
Periodic orthodontic treatment visit |
2,120 |
1,897 |
$560K |
| D1110 |
Prophylaxis - adult |
12,782 |
11,439 |
$437K |
| D0140 |
Limited oral evaluation - problem focused |
18,822 |
17,032 |
$419K |
| D0330 |
Panoramic radiographic image |
7,222 |
6,594 |
$339K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,119 |
3,971 |
$328K |
| D8030 |
|
4,615 |
3,760 |
$328K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,946 |
10,753 |
$313K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,812 |
3,525 |
$283K |
| D3320 |
|
731 |
647 |
$235K |
| D7240 |
Removal of impacted tooth - completely bony |
1,291 |
436 |
$210K |
| D0210 |
Intraoral - complete series of radiographic images |
3,650 |
3,155 |
$205K |
| D0120 |
Periodic oral evaluation - established patient |
11,173 |
10,084 |
$193K |
| D2331 |
|
2,761 |
1,607 |
$169K |
| D2330 |
|
2,783 |
1,673 |
$143K |
| D4341 |
|
1,438 |
589 |
$136K |
| D3310 |
|
488 |
392 |
$126K |
| D0274 |
Bitewings - four radiographic images |
6,232 |
5,634 |
$119K |
| D5110 |
|
336 |
274 |
$112K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,488 |
1,192 |
$110K |
| D1120 |
Prophylaxis - child |
5,546 |
5,069 |
$107K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,907 |
1,242 |
$91K |
| D1351 |
Sealant - per tooth |
4,415 |
1,225 |
$89K |
| D1206 |
Topical application of fluoride varnish |
4,889 |
4,483 |
$73K |
| D2740 |
Crown - porcelain/ceramic |
108 |
92 |
$71K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
194 |
102 |
$69K |
| D8680 |
|
626 |
310 |
$67K |
| D0340 |
|
1,023 |
942 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
12,228 |
11,106 |
$63K |
| D4342 |
|
1,219 |
544 |
$62K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,309 |
435 |
$61K |
| D2950 |
|
538 |
444 |
$54K |
| D9222 |
|
504 |
426 |
$50K |
| D5120 |
|
140 |
114 |
$46K |
| D7230 |
|
402 |
187 |
$45K |
| D4910 |
|
1,426 |
1,242 |
$45K |
| D0180 |
|
1,419 |
1,290 |
$40K |
| D2160 |
|
677 |
503 |
$40K |
| D2332 |
|
494 |
323 |
$35K |
| D9239 |
|
648 |
525 |
$35K |
| D0272 |
Bitewings - two radiographic images |
3,190 |
2,905 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,196 |
1,981 |
$29K |
| D0470 |
|
1,072 |
991 |
$26K |
| D2335 |
|
302 |
214 |
$26K |
| D9243 |
|
1,120 |
352 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,162 |
2,046 |
$23K |
| D2140 |
|
656 |
416 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
184 |
107 |
$16K |
| D0350 |
|
1,080 |
988 |
$15K |
| D7310 |
|
83 |
28 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
331 |
246 |
$3K |
| D7286 |
|
17 |
14 |
$2K |
| D9420 |
|
423 |
357 |
$0.00 |
| D0160 |
|
427 |
362 |
$0.00 |