| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
47,490 |
10,211 |
$4.52M |
| D0120 |
Periodic oral evaluation - established patient |
90,431 |
88,143 |
$2.34M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34,600 |
18,439 |
$2.15M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,186 |
3,468 |
$1.82M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27,349 |
13,738 |
$1.80M |
| D1206 |
Topical application of fluoride varnish |
98,742 |
95,091 |
$1.74M |
| D1120 |
Prophylaxis - child |
75,617 |
73,211 |
$1.68M |
| D1351 |
Sealant - per tooth |
84,674 |
22,152 |
$1.63M |
| D1110 |
Prophylaxis - adult |
33,738 |
32,499 |
$1.27M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
36,281 |
33,677 |
$1.25M |
| D0330 |
Panoramic radiographic image |
43,473 |
40,885 |
$1.21M |
| D2140 |
|
21,671 |
12,905 |
$1.12M |
| D0140 |
Limited oral evaluation - problem focused |
45,984 |
42,391 |
$1.11M |
| D5110 |
|
3,169 |
1,433 |
$1.05M |
| D7140 |
Extraction, erupted tooth or exposed root |
21,613 |
8,497 |
$1.02M |
| D0220 |
Intraoral - periapical first radiographic image |
119,603 |
111,784 |
$961K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17,374 |
10,278 |
$936K |
| D7240 |
Removal of impacted tooth - completely bony |
6,007 |
2,266 |
$862K |
| D5120 |
|
2,649 |
1,160 |
$861K |
| D7310 |
|
4,971 |
1,771 |
$851K |
| D2160 |
|
9,935 |
6,949 |
$688K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26,810 |
23,332 |
$598K |
| D0274 |
Bitewings - four radiographic images |
49,391 |
47,306 |
$578K |
| D7311 |
|
3,344 |
2,098 |
$574K |
| D2331 |
|
7,685 |
4,577 |
$517K |
| D9999 |
Unspecified adjunctive procedure, by report |
22,907 |
22,091 |
$483K |
| D0272 |
Bitewings - two radiographic images |
47,738 |
46,341 |
$452K |
| D7230 |
|
3,017 |
1,680 |
$400K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,496 |
1,685 |
$293K |
| D2332 |
|
3,799 |
2,344 |
$291K |
| D2330 |
|
5,220 |
3,170 |
$269K |
| D0230 |
Intraoral - periapical each additional radiographic image |
120,258 |
101,375 |
$265K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,273 |
1,789 |
$182K |
| D1999 |
|
14,815 |
11,802 |
$180K |
| D2390 |
|
657 |
249 |
$150K |
| D2335 |
|
1,476 |
996 |
$110K |
| D9920 |
|
4,745 |
4,589 |
$97K |
| D7473 |
|
285 |
141 |
$72K |
| D7485 |
|
230 |
120 |
$64K |
| D5710 |
|
172 |
172 |
$53K |
| D7250 |
|
592 |
155 |
$43K |
| D5711 |
|
99 |
99 |
$30K |
| D2929 |
|
127 |
38 |
$27K |
| D1510 |
|
219 |
162 |
$16K |
| D1354 |
|
4,145 |
1,131 |
$13K |
| D4346 |
|
152 |
146 |
$9K |
| D0270 |
|
1,955 |
1,885 |
$8K |
| D2161 |
|
112 |
94 |
$6K |
| D9110 |
|
133 |
105 |
$4K |
| D7220 |
|
39 |
26 |
$3K |
| D2931 |
|
17 |
14 |
$3K |
| D5411 |
|
73 |
68 |
$1K |
| D5410 |
|
42 |
41 |
$806.88 |
| D9930 |
|
23 |
15 |
$652.15 |
| D0460 |
|
441 |
418 |
$538.35 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$166.96 |
| D1330 |
|
107 |
107 |
$0.00 |
| D1353 |
|
36 |
14 |
$0.00 |
| D3120 |
|
37 |
26 |
$0.00 |