| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,403 |
1,698 |
$496K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,158 |
1,927 |
$321K |
| D0210 |
Intraoral - complete series of radiographic images |
6,011 |
5,060 |
$314K |
| D1110 |
Prophylaxis - adult |
6,297 |
5,781 |
$280K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,225 |
1,571 |
$257K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,942 |
1,881 |
$252K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,038 |
4,600 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
8,277 |
7,532 |
$177K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,550 |
877 |
$155K |
| D0140 |
Limited oral evaluation - problem focused |
4,398 |
3,938 |
$146K |
| D2140 |
|
3,074 |
1,509 |
$121K |
| D0274 |
Bitewings - four radiographic images |
4,119 |
3,772 |
$118K |
| D2160 |
|
1,248 |
690 |
$112K |
| D0330 |
Panoramic radiographic image |
2,956 |
2,713 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,626 |
859 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,386 |
4,951 |
$101K |
| D1120 |
Prophylaxis - child |
2,168 |
1,995 |
$65K |
| D4346 |
|
379 |
360 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
6,169 |
5,416 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,464 |
2,563 |
$43K |
| D2335 |
|
231 |
123 |
$37K |
| D1351 |
Sealant - per tooth |
1,423 |
254 |
$34K |
| D7250 |
|
107 |
43 |
$22K |
| D2332 |
|
196 |
115 |
$22K |
| D2394 |
|
148 |
94 |
$17K |
| D4341 |
|
78 |
25 |
$15K |
| D0272 |
Bitewings - two radiographic images |
646 |
604 |
$12K |
| D4910 |
|
100 |
80 |
$8K |
| D2331 |
|
77 |
52 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
251 |
195 |
$6K |
| D7240 |
Removal of impacted tooth - completely bony |
110 |
40 |
$2K |
| D0270 |
|
69 |
63 |
$375.45 |
| D1999 |
|
889 |
674 |
$300.72 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
12 |
$0.00 |