| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
25,022 |
7,062 |
$1.30M |
| D0330 |
Panoramic radiographic image |
10,737 |
10,369 |
$505K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,875 |
13,397 |
$400K |
| D1120 |
Prophylaxis - child |
6,958 |
6,701 |
$331K |
| D0140 |
Limited oral evaluation - problem focused |
7,484 |
7,094 |
$275K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,977 |
2,000 |
$197K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,072 |
689 |
$171K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,661 |
941 |
$157K |
| D7240 |
Removal of impacted tooth - completely bony |
560 |
219 |
$116K |
| D9222 |
|
1,446 |
1,370 |
$112K |
| D1110 |
Prophylaxis - adult |
2,216 |
2,172 |
$111K |
| D1206 |
Topical application of fluoride varnish |
6,168 |
6,031 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,286 |
987 |
$90K |
| D0274 |
Bitewings - four radiographic images |
2,483 |
2,422 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,298 |
931 |
$62K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
164 |
140 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,188 |
2,994 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,426 |
1,369 |
$34K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
302 |
121 |
$33K |
| D0473 |
|
832 |
489 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,297 |
1,263 |
$24K |
| D2394 |
|
257 |
213 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,005 |
1,909 |
$18K |
| D9239 |
|
184 |
172 |
$17K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
477 |
352 |
$15K |
| D9243 |
|
92 |
56 |
$9K |
| V2020 |
Frames, purchases |
223 |
209 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
195 |
178 |
$6K |
| D1351 |
Sealant - per tooth |
329 |
105 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
115 |
103 |
$5K |
| D2332 |
|
49 |
38 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
51 |
44 |
$3K |
| D0180 |
|
50 |
41 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
33 |
33 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
360 |
175 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
76 |
70 |
$2K |
| D4341 |
|
28 |
14 |
$2K |
| D2335 |
|
24 |
12 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
207 |
194 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
18 |
18 |
$2K |
| 70355 |
|
162 |
116 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
42 |
31 |
$838.95 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
102 |
100 |
$766.00 |
| D9420 |
|
12 |
12 |
$743.60 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15 |
15 |
$639.45 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
12 |
$628.73 |
| D0270 |
|
38 |
37 |
$341.12 |
| D9986 |
|
96 |
94 |
$282.00 |
| 92015 |
Determination of refractive state |
79 |
79 |
$40.44 |