| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18,881 |
8,909 |
$2.21M |
| D9430 |
|
27,116 |
26,763 |
$856K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,300 |
5,626 |
$677K |
| D1110 |
Prophylaxis - adult |
7,727 |
7,707 |
$654K |
| D2740 |
Crown - porcelain/ceramic |
1,372 |
1,033 |
$646K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,280 |
1,230 |
$590K |
| D7240 |
Removal of impacted tooth - completely bony |
2,495 |
1,152 |
$572K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,762 |
8,738 |
$561K |
| D0120 |
Periodic oral evaluation - established patient |
9,031 |
9,011 |
$560K |
| D7230 |
|
2,506 |
1,439 |
$468K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,762 |
4,326 |
$468K |
| D0330 |
Panoramic radiographic image |
12,789 |
12,771 |
$375K |
| D0230 |
Intraoral - periapical each additional radiographic image |
73,246 |
21,099 |
$341K |
| D0210 |
Intraoral - complete series of radiographic images |
6,572 |
6,556 |
$305K |
| D1120 |
Prophylaxis - child |
6,253 |
6,229 |
$244K |
| D0350 |
|
22,092 |
9,523 |
$237K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,830 |
1,385 |
$218K |
| D1206 |
Topical application of fluoride varnish |
14,125 |
14,075 |
$204K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
711 |
402 |
$193K |
| D4910 |
|
2,496 |
2,490 |
$189K |
| D0274 |
Bitewings - four radiographic images |
9,040 |
9,015 |
$186K |
| D4341 |
|
2,463 |
698 |
$170K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,750 |
1,352 |
$136K |
| D2954 |
|
1,042 |
799 |
$109K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
224 |
186 |
$107K |
| D3320 |
|
241 |
202 |
$87K |
| D2330 |
|
1,069 |
535 |
$79K |
| D9222 |
|
402 |
402 |
$48K |
| D9110 |
|
742 |
711 |
$46K |
| D2394 |
|
440 |
230 |
$37K |
| D0270 |
|
6,300 |
6,212 |
$31K |
| D7220 |
|
204 |
133 |
$28K |
| D9610 |
|
546 |
331 |
$27K |
| D3310 |
|
84 |
58 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,047 |
2,040 |
$23K |
| D4342 |
|
411 |
137 |
$17K |
| D1351 |
Sealant - per tooth |
605 |
161 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,245 |
1,240 |
$14K |
| D3348 |
|
13 |
12 |
$6K |
| D0999 |
Unspecified diagnostic procedure, by report |
110 |
109 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
40 |
30 |
$2K |
| D2332 |
|
18 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
109 |
109 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$767.00 |