| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
648 |
471 |
$272K |
| D0120 |
Periodic oral evaluation - established patient |
14,559 |
14,510 |
$268K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,141 |
2,503 |
$264K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,012 |
3,028 |
$234K |
| D1110 |
Prophylaxis - adult |
5,171 |
5,170 |
$198K |
| D0274 |
Bitewings - four radiographic images |
8,172 |
8,171 |
$169K |
| D0330 |
Panoramic radiographic image |
4,698 |
4,696 |
$134K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,569 |
1,566 |
$133K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,468 |
1,309 |
$86K |
| D9222 |
|
1,606 |
1,602 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,180 |
8,842 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
9,273 |
9,257 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,646 |
1,412 |
$73K |
| D7230 |
|
240 |
206 |
$50K |
| D2740 |
Crown - porcelain/ceramic |
106 |
93 |
$45K |
| D9310 |
|
1,382 |
1,379 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,434 |
1,423 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
1,729 |
1,729 |
$12K |
| D7220 |
|
53 |
49 |
$6K |
| D9610 |
|
668 |
665 |
$6K |
| D2954 |
|
35 |
32 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
146 |
146 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
28 |
$2K |
| D2331 |
|
30 |
26 |
$2K |
| D2330 |
|
34 |
27 |
$1K |
| D8660 |
|
35 |
35 |
$1K |
| D4341 |
|
14 |
13 |
$905.50 |
| D9243 |
|
12 |
12 |
$819.35 |
| D0340 |
|
13 |
13 |
$685.00 |
| D9239 |
|
12 |
12 |
$642.15 |
| D0470 |
|
12 |
12 |
$408.00 |
| D9110 |
|
18 |
17 |
$175.58 |
| D0350 |
|
13 |
13 |
$144.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
1,572 |
1,439 |
$0.00 |
| D9215 |
|
32 |
32 |
$0.00 |
| D5899 |
|
353 |
303 |
$0.00 |
| D6999 |
|
26 |
25 |
$0.00 |