| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,630 |
260 |
$100K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
962 |
262 |
$71K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
573 |
430 |
$65K |
| D1120 |
Prophylaxis - child |
993 |
836 |
$43K |
| D0330 |
Panoramic radiographic image |
1,318 |
1,226 |
$28K |
| D9310 |
|
462 |
443 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,719 |
2,421 |
$25K |
| D0367 |
|
139 |
136 |
$19K |
| D9222 |
|
423 |
375 |
$18K |
| D1206 |
Topical application of fluoride varnish |
719 |
614 |
$18K |
| D2740 |
Crown - porcelain/ceramic |
32 |
12 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
164 |
58 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,102 |
1,585 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
534 |
441 |
$12K |
| D7310 |
|
132 |
31 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
192 |
175 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
516 |
478 |
$8K |
| D0160 |
|
268 |
250 |
$8K |
| D0274 |
Bitewings - four radiographic images |
520 |
495 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
353 |
281 |
$8K |
| D4341 |
|
58 |
14 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
205 |
205 |
$5K |
| D7240 |
Removal of impacted tooth - completely bony |
41 |
12 |
$5K |
| D2950 |
|
34 |
13 |
$4K |
| D9612 |
|
126 |
126 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
29 |
$3K |
| D0272 |
Bitewings - two radiographic images |
176 |
151 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
26 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
288 |
257 |
$2K |
| D4212 |
|
32 |
12 |
$2K |
| D9215 |
|
492 |
430 |
$2K |
| D9610 |
|
126 |
126 |
$2K |
| D0240 |
|
201 |
155 |
$2K |
| D0340 |
|
65 |
39 |
$1K |
| D1351 |
Sealant - per tooth |
44 |
13 |
$989.94 |
| D1354 |
|
73 |
12 |
$836.40 |
| D9420 |
|
13 |
13 |
$532.87 |
| D0350 |
|
26 |
24 |
$410.00 |
| D9630 |
|
12 |
12 |
$273.80 |
| D0170 |
|
22 |
13 |
$73.76 |
| D9221 |
|
60 |
19 |
$0.00 |