| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64,887 |
18,678 |
$3.75M |
| D7250 |
|
20,200 |
6,413 |
$2.10M |
| D0140 |
Limited oral evaluation - problem focused |
88,198 |
72,802 |
$1.94M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,537 |
7,707 |
$987K |
| D7230 |
|
6,927 |
3,174 |
$957K |
| D1120 |
Prophylaxis - child |
22,417 |
20,015 |
$871K |
| D0120 |
Periodic oral evaluation - established patient |
36,262 |
31,993 |
$822K |
| D0330 |
Panoramic radiographic image |
37,085 |
22,738 |
$795K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32,568 |
21,075 |
$779K |
| D1110 |
Prophylaxis - adult |
27,422 |
23,780 |
$742K |
| D0274 |
Bitewings - four radiographic images |
27,962 |
24,019 |
$680K |
| D1208 |
Topical application of fluoride, excluding varnish |
26,507 |
23,315 |
$557K |
| D0220 |
Intraoral - periapical first radiographic image |
59,504 |
48,860 |
$518K |
| D0210 |
Intraoral - complete series of radiographic images |
10,207 |
8,279 |
$383K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,900 |
3,485 |
$351K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,758 |
2,155 |
$335K |
| D7240 |
Removal of impacted tooth - completely bony |
2,984 |
677 |
$307K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,011 |
594 |
$301K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,448 |
7,085 |
$291K |
| D8670 |
Periodic orthodontic treatment visit |
3,815 |
3,789 |
$260K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,668 |
1,833 |
$241K |
| D7220 |
|
1,861 |
926 |
$224K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,736 |
11,509 |
$172K |
| D9310 |
|
8,318 |
6,683 |
$132K |
| D2335 |
|
1,447 |
588 |
$123K |
| D0272 |
Bitewings - two radiographic images |
4,448 |
4,036 |
$121K |
| D2332 |
|
1,302 |
618 |
$96K |
| D1206 |
Topical application of fluoride varnish |
3,717 |
3,191 |
$78K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,373 |
895 |
$73K |
| D2950 |
|
2,504 |
922 |
$64K |
| D5110 |
|
150 |
111 |
$62K |
| D1351 |
Sealant - per tooth |
1,657 |
682 |
$55K |
| D2394 |
|
525 |
322 |
$42K |
| D0270 |
|
8,720 |
7,005 |
$42K |
| D8660 |
|
1,347 |
1,158 |
$33K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
125 |
55 |
$24K |
| D2140 |
|
504 |
314 |
$23K |
| D3320 |
|
48 |
38 |
$16K |
| D2330 |
|
355 |
143 |
$16K |
| D2954 |
|
165 |
97 |
$16K |
| D2160 |
|
196 |
153 |
$14K |
| D2331 |
|
231 |
139 |
$13K |
| D2940 |
|
227 |
151 |
$5K |
| D3310 |
|
19 |
13 |
$5K |
| D2791 |
|
17 |
12 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12 |
12 |
$2K |
| D7510 |
|
18 |
13 |
$486.72 |
| D0160 |
|
25 |
12 |
$254.00 |
| D0603 |
|
95 |
79 |
$0.00 |
| D0602 |
|
103 |
83 |
$0.00 |