| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
30,506 |
15,527 |
$2.12M |
| D8670 |
Periodic orthodontic treatment visit |
28,879 |
28,470 |
$1.24M |
| D0140 |
Limited oral evaluation - problem focused |
44,489 |
38,403 |
$1.21M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,018 |
1,508 |
$859K |
| D1120 |
Prophylaxis - child |
21,615 |
20,373 |
$857K |
| D0120 |
Periodic oral evaluation - established patient |
28,054 |
26,633 |
$714K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,703 |
6,900 |
$639K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
6,289 |
1,641 |
$542K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,364 |
5,589 |
$539K |
| D0330 |
Panoramic radiographic image |
13,799 |
12,124 |
$499K |
| D1206 |
Topical application of fluoride varnish |
20,336 |
19,197 |
$482K |
| D0220 |
Intraoral - periapical first radiographic image |
36,243 |
31,841 |
$421K |
| D1110 |
Prophylaxis - adult |
13,094 |
11,894 |
$371K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,412 |
9,354 |
$366K |
| D1351 |
Sealant - per tooth |
15,365 |
4,803 |
$324K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,837 |
1,545 |
$285K |
| D0274 |
Bitewings - four radiographic images |
8,103 |
7,694 |
$250K |
| D0272 |
Bitewings - two radiographic images |
9,019 |
8,657 |
$233K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,590 |
3,949 |
$226K |
| D2330 |
|
3,460 |
2,170 |
$201K |
| D2331 |
|
1,847 |
1,337 |
$148K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,009 |
6,651 |
$143K |
| D2940 |
|
3,848 |
2,887 |
$138K |
| D0210 |
Intraoral - complete series of radiographic images |
2,029 |
1,737 |
$103K |
| D3310 |
|
275 |
183 |
$83K |
| D3320 |
|
252 |
173 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
908 |
763 |
$72K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
363 |
209 |
$62K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
948 |
331 |
$51K |
| D0191 |
|
1,536 |
1,331 |
$45K |
| D5110 |
|
116 |
96 |
$41K |
| D0270 |
|
6,491 |
5,976 |
$39K |
| D9222 |
|
784 |
413 |
$35K |
| D9310 |
|
1,956 |
1,844 |
$35K |
| D0190 |
|
1,177 |
1,120 |
$33K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
298 |
237 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,363 |
1,325 |
$30K |
| D2791 |
|
99 |
72 |
$28K |
| D0240 |
|
1,943 |
1,593 |
$23K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
825 |
597 |
$21K |
| D2332 |
|
197 |
142 |
$19K |
| D2140 |
|
406 |
314 |
$18K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
33 |
32 |
$18K |
| D0999 |
Unspecified diagnostic procedure, by report |
508 |
479 |
$17K |
| D2950 |
|
440 |
231 |
$15K |
| D0364 |
|
269 |
211 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
226 |
201 |
$12K |
| D0470 |
|
175 |
171 |
$11K |
| D2335 |
|
49 |
37 |
$7K |
| D0340 |
|
49 |
46 |
$5K |
| D8660 |
|
122 |
118 |
$4K |
| D0367 |
|
91 |
53 |
$2K |
| D0180 |
|
24 |
15 |
$1K |
| D9239 |
|
20 |
12 |
$652.46 |
| D7510 |
|
13 |
12 |
$514.80 |
| D1320 |
|
68 |
61 |
$356.13 |
| D9997 |
|
80 |
65 |
$300.00 |
| D9110 |
|
470 |
416 |
$0.00 |
| D1354 |
|
4,855 |
1,691 |
$0.00 |
| D9920 |
|
56 |
52 |
$0.00 |
| D4342 |
|
80 |
40 |
$0.00 |
| 99241 |
|
36 |
30 |
$0.00 |