| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
27,640 |
11,931 |
$1.81M |
| D7240 |
Removal of impacted tooth - completely bony |
2,602 |
1,037 |
$648K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,999 |
3,193 |
$628K |
| D1120 |
Prophylaxis - child |
9,383 |
8,623 |
$439K |
| D0140 |
Limited oral evaluation - problem focused |
12,573 |
10,503 |
$403K |
| D7230 |
|
2,293 |
1,477 |
$367K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,904 |
6,875 |
$242K |
| D0120 |
Periodic oral evaluation - established patient |
7,668 |
7,092 |
$203K |
| D1206 |
Topical application of fluoride varnish |
5,873 |
5,391 |
$139K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,520 |
4,169 |
$124K |
| D9110 |
|
3,824 |
3,267 |
$120K |
| D1351 |
Sealant - per tooth |
2,600 |
706 |
$93K |
| D0330 |
Panoramic radiographic image |
1,362 |
1,107 |
$85K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,117 |
542 |
$82K |
| D0272 |
Bitewings - two radiographic images |
2,378 |
2,156 |
$65K |
| D1110 |
Prophylaxis - adult |
978 |
905 |
$59K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,386 |
1,352 |
$53K |
| D9222 |
|
614 |
537 |
$44K |
| D0340 |
|
564 |
381 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
314 |
211 |
$26K |
| D0274 |
Bitewings - four radiographic images |
634 |
600 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,424 |
1,275 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
850 |
773 |
$20K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
285 |
284 |
$10K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
183 |
181 |
$10K |
| D7220 |
|
89 |
53 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
459 |
266 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
43 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
51 |
50 |
$3K |
| D7250 |
|
24 |
12 |
$3K |
| D1354 |
|
116 |
27 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
73 |
69 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$1K |
| D7251 |
|
14 |
13 |
$1K |
| D0160 |
|
54 |
54 |
$0.00 |
| D0603 |
|
26 |
23 |
$0.00 |
| D0170 |
|
199 |
159 |
$0.00 |
| D9995 |
|
639 |
623 |
$0.00 |
| D9612 |
|
46 |
40 |
$0.00 |