| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,709 |
3,060 |
$793K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,091 |
12,073 |
$780K |
| D2740 |
Crown - porcelain/ceramic |
1,220 |
899 |
$581K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,241 |
1,107 |
$575K |
| D0120 |
Periodic oral evaluation - established patient |
9,485 |
9,449 |
$548K |
| D1120 |
Prophylaxis - child |
11,216 |
11,162 |
$447K |
| D7240 |
Removal of impacted tooth - completely bony |
1,755 |
835 |
$405K |
| D0230 |
Intraoral - periapical each additional radiographic image |
91,742 |
15,925 |
$372K |
| D1351 |
Sealant - per tooth |
8,295 |
2,130 |
$237K |
| D1110 |
Prophylaxis - adult |
2,684 |
2,681 |
$225K |
| D0330 |
Panoramic radiographic image |
7,301 |
7,291 |
$215K |
| D7230 |
|
1,138 |
695 |
$215K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,589 |
1,274 |
$195K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,597 |
1,190 |
$174K |
| D4341 |
|
2,391 |
698 |
$167K |
| D0210 |
Intraoral - complete series of radiographic images |
3,408 |
3,404 |
$160K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,181 |
11,126 |
$155K |
| D3320 |
|
377 |
328 |
$138K |
| D8670 |
Periodic orthodontic treatment visit |
428 |
428 |
$114K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,692 |
836 |
$113K |
| D2954 |
|
1,076 |
789 |
$113K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,722 |
2,697 |
$108K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,795 |
920 |
$103K |
| D1310 |
|
2,241 |
2,223 |
$102K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
820 |
368 |
$97K |
| D0272 |
Bitewings - two radiographic images |
7,897 |
7,870 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
7,316 |
7,246 |
$86K |
| D4910 |
|
1,046 |
1,038 |
$81K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
752 |
343 |
$74K |
| D2160 |
|
907 |
558 |
$72K |
| D9430 |
|
2,024 |
1,999 |
$65K |
| D4342 |
|
1,437 |
501 |
$60K |
| D9993 |
|
958 |
958 |
$59K |
| D2931 |
|
285 |
202 |
$36K |
| D0340 |
|
691 |
688 |
$33K |
| D7220 |
|
194 |
139 |
$27K |
| D1510 |
|
172 |
129 |
$26K |
| D0603 |
|
1,728 |
1,711 |
$26K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
39 |
26 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
493 |
491 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
237 |
229 |
$14K |
| D2161 |
|
79 |
56 |
$7K |
| D3310 |
|
17 |
12 |
$5K |
| D7111 |
|
71 |
32 |
$4K |
| D0350 |
|
335 |
97 |
$3K |
| D0601 |
|
173 |
173 |
$3K |
| D0602 |
|
25 |
25 |
$375.00 |