| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17,851 |
6,320 |
$2.50M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18,888 |
9,255 |
$1.17M |
| D7140 |
Extraction, erupted tooth or exposed root |
16,511 |
4,646 |
$1.17M |
| D0210 |
Intraoral - complete series of radiographic images |
21,824 |
16,533 |
$1.03M |
| D1110 |
Prophylaxis - adult |
22,788 |
19,140 |
$863K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26,538 |
21,737 |
$827K |
| D7240 |
Removal of impacted tooth - completely bony |
3,538 |
1,013 |
$818K |
| D7250 |
|
4,274 |
1,400 |
$759K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
8,290 |
4,675 |
$621K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,728 |
6,631 |
$609K |
| D0120 |
Periodic oral evaluation - established patient |
29,576 |
25,396 |
$526K |
| D0140 |
Limited oral evaluation - problem focused |
16,368 |
13,464 |
$519K |
| D2335 |
|
3,768 |
1,977 |
$511K |
| D5110 |
|
1,568 |
1,262 |
$463K |
| D1351 |
Sealant - per tooth |
21,249 |
3,145 |
$452K |
| D7230 |
|
1,739 |
806 |
$400K |
| D0330 |
Panoramic radiographic image |
10,888 |
8,613 |
$397K |
| D0274 |
Bitewings - four radiographic images |
14,300 |
11,903 |
$381K |
| D2332 |
|
3,929 |
2,244 |
$367K |
| D4341 |
|
4,082 |
1,055 |
$359K |
| D1206 |
Topical application of fluoride varnish |
24,305 |
20,648 |
$341K |
| D1120 |
Prophylaxis - child |
14,223 |
11,914 |
$331K |
| D5120 |
|
1,121 |
880 |
$324K |
| D4346 |
|
2,652 |
2,188 |
$267K |
| D2331 |
|
3,273 |
1,957 |
$259K |
| D2394 |
|
2,478 |
1,510 |
$221K |
| D2330 |
|
3,089 |
1,749 |
$211K |
| D0220 |
Intraoral - periapical first radiographic image |
22,034 |
16,573 |
$194K |
| D0272 |
Bitewings - two radiographic images |
8,195 |
6,811 |
$138K |
| D4910 |
|
1,857 |
1,524 |
$121K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,068 |
3,857 |
$88K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,658 |
6,332 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,369 |
2,616 |
$35K |
| D4342 |
|
1,435 |
355 |
$34K |
| D0270 |
|
1,216 |
1,043 |
$20K |
| D7220 |
|
90 |
52 |
$16K |
| D7111 |
|
362 |
156 |
$14K |
| D5212 |
|
61 |
34 |
$10K |
| D5130 |
|
57 |
39 |
$10K |
| D4355 |
|
177 |
116 |
$10K |
| D5140 |
|
51 |
28 |
$9K |
| D7310 |
|
75 |
25 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
85 |
39 |
$5K |
| D5750 |
|
14 |
12 |
$2K |
| D1352 |
|
48 |
12 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
24 |
12 |
$1K |
| D0240 |
|
67 |
24 |
$758.50 |
| D9920 |
|
22 |
13 |
$187.00 |
| D1999 |
|
39 |
33 |
$40.00 |
| D0431 |
|
2,577 |
2,220 |
$0.00 |
| D4921 |
|
461 |
291 |
$0.00 |
| D2950 |
|
42 |
28 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
19 |
13 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
98 |
64 |
$0.00 |