| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27,730 |
9,198 |
$3.70M |
| D7240 |
Removal of impacted tooth - completely bony |
6,709 |
2,271 |
$1.70M |
| D1110 |
Prophylaxis - adult |
30,631 |
26,975 |
$1.28M |
| D0330 |
Panoramic radiographic image |
16,108 |
13,840 |
$713K |
| D0120 |
Periodic oral evaluation - established patient |
34,381 |
30,393 |
$678K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,052 |
3,057 |
$658K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,354 |
6,183 |
$637K |
| D0140 |
Limited oral evaluation - problem focused |
18,212 |
15,247 |
$611K |
| D0274 |
Bitewings - four radiographic images |
18,149 |
15,840 |
$502K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,984 |
3,294 |
$372K |
| D7230 |
|
1,669 |
1,059 |
$354K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,066 |
9,671 |
$347K |
| D1120 |
Prophylaxis - child |
11,837 |
10,357 |
$308K |
| D0210 |
Intraoral - complete series of radiographic images |
12,840 |
9,867 |
$295K |
| D2335 |
|
2,246 |
1,330 |
$286K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,619 |
16,371 |
$285K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,504 |
3,632 |
$252K |
| D2332 |
|
2,584 |
1,522 |
$243K |
| D9239 |
|
2,465 |
2,079 |
$141K |
| D9243 |
|
2,611 |
1,777 |
$135K |
| D0220 |
Intraoral - periapical first radiographic image |
12,834 |
10,304 |
$119K |
| D2394 |
|
1,053 |
766 |
$96K |
| D7250 |
|
754 |
331 |
$86K |
| D2331 |
|
1,065 |
704 |
$78K |
| D1354 |
|
1,209 |
250 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,096 |
4,331 |
$60K |
| D1206 |
Topical application of fluoride varnish |
3,251 |
2,812 |
$60K |
| D2330 |
|
969 |
590 |
$59K |
| D0272 |
Bitewings - two radiographic images |
3,287 |
2,820 |
$58K |
| D7220 |
|
316 |
198 |
$53K |
| D1351 |
Sealant - per tooth |
2,376 |
519 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,577 |
1,165 |
$29K |
| D4341 |
|
361 |
89 |
$25K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
250 |
98 |
$21K |
| D4910 |
|
313 |
240 |
$17K |
| D1510 |
|
29 |
14 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
151 |
102 |
$2K |
| D2140 |
|
80 |
48 |
$282.94 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
100 |
31 |
$113.55 |
| D1999 |
|
383 |
279 |
$110.00 |
| D2740 |
Crown - porcelain/ceramic |
119 |
79 |
$0.00 |
| D2950 |
|
20 |
15 |
$0.00 |
| D0350 |
|
26 |
26 |
$0.00 |
| D3120 |
|
395 |
274 |
$0.00 |
| D1330 |
|
79 |
75 |
$0.00 |