| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
21,781 |
9,078 |
$1.56M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,085 |
1,978 |
$1.35M |
| D8670 |
Periodic orthodontic treatment visit |
2,867 |
2,732 |
$674K |
| D0140 |
Limited oral evaluation - problem focused |
12,278 |
11,752 |
$447K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,085 |
2,115 |
$416K |
| D2740 |
Crown - porcelain/ceramic |
620 |
179 |
$414K |
| D1120 |
Prophylaxis - child |
5,898 |
5,782 |
$300K |
| D3320 |
|
604 |
541 |
$297K |
| D1110 |
Prophylaxis - adult |
4,277 |
4,141 |
$217K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,031 |
1,490 |
$206K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,847 |
3,748 |
$204K |
| D1206 |
Topical application of fluoride varnish |
7,081 |
6,947 |
$184K |
| D0330 |
Panoramic radiographic image |
2,794 |
2,717 |
$166K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,943 |
1,270 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
5,009 |
4,914 |
$136K |
| D3348 |
|
218 |
206 |
$123K |
| D1351 |
Sealant - per tooth |
3,146 |
1,045 |
$121K |
| D3310 |
|
274 |
219 |
$109K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
141 |
50 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
4,580 |
4,314 |
$75K |
| D0274 |
Bitewings - four radiographic images |
1,915 |
1,871 |
$74K |
| D0272 |
Bitewings - two radiographic images |
2,257 |
2,202 |
$65K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
756 |
373 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
733 |
699 |
$46K |
| D9110 |
|
825 |
774 |
$39K |
| D9222 |
|
438 |
413 |
$33K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
29 |
25 |
$28K |
| D8660 |
|
332 |
311 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,408 |
1,069 |
$18K |
| D4341 |
|
138 |
58 |
$11K |
| D8680 |
|
105 |
97 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
440 |
398 |
$8K |
| D7230 |
|
22 |
13 |
$5K |
| D8690 |
|
40 |
40 |
$4K |
| D0340 |
|
149 |
145 |
$4K |
| D4342 |
|
30 |
15 |
$2K |
| D7111 |
|
24 |
16 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
15 |
$2K |
| D1354 |
|
34 |
13 |
$480.00 |