| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,766 |
3,319 |
$375K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,575 |
1,464 |
$233K |
| D9310 |
|
4,946 |
4,940 |
$222K |
| D8670 |
Periodic orthodontic treatment visit |
881 |
881 |
$194K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,746 |
1,213 |
$191K |
| D0330 |
Panoramic radiographic image |
5,580 |
5,571 |
$163K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,357 |
1,306 |
$149K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,177 |
919 |
$116K |
| D7240 |
Removal of impacted tooth - completely bony |
285 |
251 |
$114K |
| D1120 |
Prophylaxis - child |
2,672 |
2,672 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
2,992 |
2,990 |
$69K |
| D0160 |
|
4,055 |
4,038 |
$67K |
| D9222 |
|
1,145 |
1,132 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
5,581 |
5,464 |
$56K |
| D1110 |
Prophylaxis - adult |
1,087 |
1,086 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,090 |
3,089 |
$40K |
| D1351 |
Sealant - per tooth |
694 |
332 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,138 |
1,137 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,476 |
3,451 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,680 |
1,679 |
$22K |
| D7230 |
|
102 |
99 |
$19K |
| D1206 |
Topical application of fluoride varnish |
539 |
539 |
$14K |
| D0340 |
|
312 |
312 |
$14K |
| D4341 |
|
213 |
139 |
$14K |
| D8660 |
|
337 |
337 |
$10K |
| D0270 |
|
779 |
779 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
257 |
257 |
$7K |
| D7250 |
|
92 |
68 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
434 |
433 |
$5K |
| D0350 |
|
426 |
426 |
$5K |
| D7310 |
|
74 |
61 |
$4K |
| D2335 |
|
16 |
16 |
$2K |
| D0240 |
|
120 |
117 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
190 |
188 |
$1K |
| D2330 |
|
20 |
20 |
$984.30 |
| D0273 |
|
26 |
26 |
$500.83 |
| D1330 |
|
936 |
934 |
$0.00 |
| D3221 |
|
32 |
30 |
$0.00 |
| D0460 |
|
1,408 |
1,342 |
$0.00 |
| D1999 |
|
509 |
494 |
$0.00 |