| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
14,731 |
10,662 |
$375K |
| D0140 |
Limited oral evaluation - problem focused |
14,542 |
13,378 |
$152K |
| D0330 |
Panoramic radiographic image |
7,947 |
7,867 |
$86K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,004 |
1,645 |
$69K |
| D1120 |
Prophylaxis - child |
5,192 |
5,147 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
4,776 |
4,362 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,821 |
3,520 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
8,253 |
8,004 |
$32K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
739 |
405 |
$32K |
| D9310 |
|
1,629 |
1,597 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,219 |
6,196 |
$28K |
| D1351 |
Sealant - per tooth |
1,456 |
759 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
898 |
754 |
$23K |
| D1110 |
Prophylaxis - adult |
1,250 |
1,201 |
$19K |
| D0274 |
Bitewings - four radiographic images |
2,384 |
2,369 |
$17K |
| D0272 |
Bitewings - two radiographic images |
3,142 |
3,076 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
745 |
626 |
$13K |
| D9110 |
|
1,164 |
1,127 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,904 |
2,873 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
779 |
762 |
$7K |
| D9243 |
|
312 |
310 |
$4K |
| D7111 |
|
162 |
120 |
$4K |
| D0240 |
|
488 |
413 |
$3K |
| D1354 |
|
333 |
128 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
188 |
162 |
$1K |
| D0270 |
|
278 |
269 |
$903.37 |
| D9222 |
|
32 |
32 |
$548.78 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
13 |
13 |
$238.64 |