| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
15,673 |
8,898 |
$1.59M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,788 |
9,545 |
$1.30M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,890 |
10,096 |
$1.18M |
| D0330 |
Panoramic radiographic image |
16,058 |
15,113 |
$831K |
| D4341 |
|
6,964 |
4,293 |
$781K |
| D2740 |
Crown - porcelain/ceramic |
1,240 |
1,004 |
$745K |
| D2752 |
|
1,432 |
1,160 |
$728K |
| D0120 |
Periodic oral evaluation - established patient |
19,307 |
18,192 |
$621K |
| D0140 |
Limited oral evaluation - problem focused |
17,533 |
16,393 |
$617K |
| D1120 |
Prophylaxis - child |
12,611 |
11,919 |
$561K |
| D0210 |
Intraoral - complete series of radiographic images |
10,008 |
9,407 |
$502K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,709 |
11,913 |
$500K |
| D2950 |
|
3,187 |
2,730 |
$417K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,276 |
1,897 |
$408K |
| D5110 |
|
679 |
648 |
$400K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,153 |
2,673 |
$388K |
| D3310 |
|
945 |
800 |
$320K |
| D4342 |
|
3,576 |
2,359 |
$272K |
| D2331 |
|
2,841 |
2,334 |
$268K |
| D1351 |
Sealant - per tooth |
4,703 |
2,907 |
$268K |
| D0274 |
Bitewings - four radiographic images |
8,659 |
8,149 |
$264K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,133 |
5,279 |
$264K |
| D1206 |
Topical application of fluoride varnish |
8,211 |
7,706 |
$246K |
| D5120 |
|
385 |
373 |
$229K |
| D1110 |
Prophylaxis - adult |
4,673 |
4,317 |
$229K |
| D2330 |
|
2,793 |
2,148 |
$225K |
| D0220 |
Intraoral - periapical first radiographic image |
14,237 |
13,068 |
$190K |
| D4910 |
|
3,118 |
2,907 |
$185K |
| D9630 |
|
7,689 |
7,063 |
$182K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,360 |
1,036 |
$163K |
| D2332 |
|
1,101 |
906 |
$121K |
| D0272 |
Bitewings - two radiographic images |
5,393 |
5,117 |
$103K |
| D0270 |
|
6,079 |
5,711 |
$90K |
| D2335 |
|
644 |
527 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,874 |
3,285 |
$57K |
| D2750 |
|
140 |
107 |
$39K |
| D2940 |
|
514 |
453 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
20 |
17 |
$16K |
| D1354 |
|
278 |
157 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
44 |
41 |
$4K |
| D2931 |
|
28 |
24 |
$2K |