| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19,381 |
9,353 |
$2.06M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,102 |
2,395 |
$1.14M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,003 |
4,298 |
$1.04M |
| D0330 |
Panoramic radiographic image |
15,575 |
15,015 |
$871K |
| D0140 |
Limited oral evaluation - problem focused |
22,753 |
21,974 |
$798K |
| D0120 |
Periodic oral evaluation - established patient |
21,461 |
21,190 |
$552K |
| D7240 |
Removal of impacted tooth - completely bony |
2,451 |
961 |
$446K |
| D1120 |
Prophylaxis - child |
15,815 |
15,523 |
$432K |
| D7250 |
|
3,696 |
1,494 |
$426K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,758 |
9,410 |
$406K |
| D1110 |
Prophylaxis - adult |
10,061 |
9,859 |
$379K |
| D0274 |
Bitewings - four radiographic images |
10,995 |
10,713 |
$341K |
| D0220 |
Intraoral - periapical first radiographic image |
21,015 |
20,231 |
$308K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,946 |
5,504 |
$254K |
| D1206 |
Topical application of fluoride varnish |
13,766 |
13,541 |
$228K |
| D1351 |
Sealant - per tooth |
6,849 |
1,664 |
$186K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,604 |
7,369 |
$181K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,082 |
1,243 |
$158K |
| D7230 |
|
879 |
537 |
$141K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,635 |
743 |
$132K |
| D0272 |
Bitewings - two radiographic images |
7,152 |
7,004 |
$132K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,125 |
1,157 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,906 |
7,729 |
$125K |
| D7311 |
|
1,274 |
832 |
$118K |
| D0240 |
|
4,000 |
1,990 |
$63K |
| D8670 |
Periodic orthodontic treatment visit |
976 |
935 |
$61K |
| D2390 |
|
366 |
149 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
443 |
288 |
$53K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
415 |
252 |
$38K |
| D4346 |
|
892 |
885 |
$35K |
| D4341 |
|
66 |
28 |
$7K |
| D2160 |
|
58 |
36 |
$7K |
| D7111 |
|
124 |
83 |
$6K |
| D1510 |
|
35 |
30 |
$6K |
| D4355 |
|
76 |
71 |
$5K |
| D2330 |
|
75 |
51 |
$5K |
| D2335 |
|
26 |
24 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
86 |
83 |
$3K |
| D7310 |
|
24 |
12 |
$2K |
| D2950 |
|
14 |
12 |
$1K |
| D4342 |
|
23 |
12 |
$1K |
| D1354 |
|
110 |
28 |
$529.00 |
| D9630 |
|
615 |
570 |
$0.00 |