| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35,063 |
5,544 |
$2.82M |
| D7970 |
|
3,520 |
2,311 |
$839K |
| D7311 |
|
8,171 |
4,340 |
$656K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
12,389 |
3,518 |
$629K |
| D7511 |
|
6,183 |
3,223 |
$542K |
| D9310 |
|
8,940 |
7,971 |
$503K |
| D7220 |
|
2,410 |
1,250 |
$289K |
| D7310 |
|
3,446 |
1,376 |
$228K |
| D7961 |
|
1,775 |
1,165 |
$212K |
| D0330 |
Panoramic radiographic image |
5,999 |
5,175 |
$152K |
| D9612 |
|
3,472 |
3,348 |
$132K |
| D9222 |
|
2,345 |
2,265 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
3,618 |
3,338 |
$115K |
| D7960 |
|
1,075 |
665 |
$113K |
| D7240 |
Removal of impacted tooth - completely bony |
794 |
328 |
$108K |
| D7951 |
|
131 |
79 |
$100K |
| D8660 |
|
2,396 |
2,071 |
$80K |
| D5110 |
|
125 |
117 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,541 |
1,491 |
$49K |
| D7971 |
|
445 |
276 |
$46K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
19 |
15 |
$42K |
| D5120 |
|
69 |
67 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
662 |
596 |
$32K |
| D1206 |
Topical application of fluoride varnish |
702 |
673 |
$31K |
| D7250 |
|
412 |
123 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,975 |
1,837 |
$28K |
| D7953 |
|
99 |
24 |
$28K |
| D1120 |
Prophylaxis - child |
524 |
502 |
$23K |
| D1351 |
Sealant - per tooth |
908 |
122 |
$18K |
| D5130 |
|
26 |
26 |
$17K |
| D4266 |
|
97 |
25 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,957 |
1,076 |
$16K |
| D5140 |
|
24 |
24 |
$15K |
| D5899 |
|
728 |
441 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
610 |
577 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
235 |
37 |
$10K |
| D0274 |
Bitewings - four radiographic images |
396 |
379 |
$8K |
| D7241 |
|
27 |
14 |
$6K |
| D0190 |
|
1,646 |
1,388 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
75 |
75 |
$3K |
| D0272 |
Bitewings - two radiographic images |
196 |
165 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
26 |
$3K |
| D0350 |
|
168 |
108 |
$2K |
| D9212 |
|
172 |
104 |
$2K |
| D9248 |
|
45 |
41 |
$2K |
| D0340 |
|
48 |
32 |
$1K |
| D7510 |
|
13 |
12 |
$984.00 |
| D0470 |
|
48 |
32 |
$819.84 |
| D1110 |
Prophylaxis - adult |
28 |
28 |
$706.00 |
| D0270 |
|
60 |
57 |
$601.29 |
| D0999 |
Unspecified diagnostic procedure, by report |
13 |
13 |
$390.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$260.00 |
| D9215 |
|
13 |
13 |
$24.60 |
| D0603 |
|
99 |
87 |
$17.00 |
| D0602 |
|
36 |
31 |
$7.00 |
| D1999 |
|
2,122 |
1,843 |
$0.00 |