| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
12,697 |
3,633 |
$1.26M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,551 |
3,332 |
$603K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,588 |
2,583 |
$548K |
| D0274 |
Bitewings - four radiographic images |
14,114 |
13,499 |
$419K |
| D1110 |
Prophylaxis - adult |
9,478 |
9,056 |
$408K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,123 |
10,664 |
$383K |
| D1120 |
Prophylaxis - child |
8,846 |
8,508 |
$376K |
| D0220 |
Intraoral - periapical first radiographic image |
24,444 |
22,789 |
$374K |
| D1351 |
Sealant - per tooth |
9,102 |
1,966 |
$373K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,255 |
13,679 |
$345K |
| D0120 |
Periodic oral evaluation - established patient |
10,651 |
10,223 |
$299K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,243 |
1,967 |
$276K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,981 |
18,799 |
$255K |
| D0140 |
Limited oral evaluation - problem focused |
5,294 |
5,046 |
$232K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,408 |
911 |
$183K |
| D2332 |
|
1,130 |
545 |
$116K |
| D5110 |
|
694 |
207 |
$109K |
| D4341 |
|
834 |
386 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,855 |
1,591 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
2,000 |
1,924 |
$90K |
| D0330 |
Panoramic radiographic image |
1,073 |
1,046 |
$67K |
| D4355 |
|
763 |
733 |
$60K |
| D0272 |
Bitewings - two radiographic images |
3,287 |
3,187 |
$56K |
| D2330 |
|
359 |
237 |
$24K |
| D5120 |
|
202 |
46 |
$20K |
| D2331 |
|
192 |
97 |
$19K |
| D3310 |
|
72 |
54 |
$17K |
| D2950 |
|
131 |
103 |
$10K |
| D1206 |
Topical application of fluoride varnish |
162 |
128 |
$4K |
| D2335 |
|
34 |
25 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
12 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
13 |
$2K |
| D2140 |
|
16 |
12 |
$1K |
| D0270 |
|
15 |
12 |
$61.60 |