| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22,598 |
5,618 |
$2.41M |
| D7240 |
Removal of impacted tooth - completely bony |
4,443 |
1,572 |
$689K |
| D1110 |
Prophylaxis - adult |
10,600 |
10,296 |
$469K |
| D0140 |
Limited oral evaluation - problem focused |
15,786 |
14,897 |
$446K |
| D5110 |
|
667 |
602 |
$430K |
| D7311 |
|
2,489 |
1,570 |
$429K |
| D0330 |
Panoramic radiographic image |
14,750 |
14,185 |
$426K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
6,558 |
3,710 |
$411K |
| D7230 |
|
2,406 |
1,236 |
$368K |
| D0120 |
Periodic oral evaluation - established patient |
13,081 |
12,802 |
$360K |
| D7310 |
|
1,967 |
768 |
$344K |
| D5120 |
|
503 |
463 |
$339K |
| D1206 |
Topical application of fluoride varnish |
16,732 |
16,240 |
$294K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,324 |
7,024 |
$280K |
| D0220 |
Intraoral - periapical first radiographic image |
21,917 |
20,678 |
$202K |
| D0274 |
Bitewings - four radiographic images |
14,524 |
14,098 |
$190K |
| D2160 |
|
2,246 |
1,570 |
$172K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,630 |
1,271 |
$171K |
| D2140 |
|
3,046 |
1,730 |
$136K |
| D2331 |
|
1,846 |
1,109 |
$121K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,723 |
1,264 |
$111K |
| D1120 |
Prophylaxis - child |
4,835 |
4,718 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,746 |
1,129 |
$87K |
| D1351 |
Sealant - per tooth |
2,513 |
729 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,699 |
18,136 |
$49K |
| D2335 |
|
351 |
258 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
366 |
324 |
$39K |
| D2330 |
|
949 |
483 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,598 |
1,424 |
$35K |
| D7250 |
|
286 |
61 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,492 |
2,439 |
$24K |
| D1999 |
|
1,779 |
1,565 |
$23K |
| D5710 |
|
69 |
68 |
$20K |
| D2332 |
|
279 |
188 |
$20K |
| D9999 |
Unspecified adjunctive procedure, by report |
458 |
448 |
$10K |
| D7485 |
|
26 |
15 |
$8K |
| D5711 |
|
24 |
24 |
$7K |
| D2931 |
|
40 |
32 |
$6K |
| D0270 |
|
1,010 |
964 |
$5K |
| D5411 |
|
100 |
94 |
$1K |
| D5410 |
|
80 |
78 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$185.50 |
| D0460 |
|
13 |
13 |
$4.85 |