| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,715 |
1,926 |
$765K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,794 |
2,889 |
$611K |
| D2394 |
|
4,892 |
2,155 |
$505K |
| D1110 |
Prophylaxis - adult |
8,708 |
8,041 |
$423K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,963 |
2,341 |
$356K |
| D0140 |
Limited oral evaluation - problem focused |
8,619 |
6,991 |
$312K |
| D0274 |
Bitewings - four radiographic images |
6,866 |
6,227 |
$217K |
| D2335 |
|
1,305 |
522 |
$203K |
| D0120 |
Periodic oral evaluation - established patient |
8,766 |
8,113 |
$199K |
| D0330 |
Panoramic radiographic image |
4,112 |
3,624 |
$195K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,097 |
4,620 |
$189K |
| D1351 |
Sealant - per tooth |
5,192 |
892 |
$137K |
| D1120 |
Prophylaxis - child |
4,131 |
3,736 |
$128K |
| D2332 |
|
1,081 |
554 |
$119K |
| D0210 |
Intraoral - complete series of radiographic images |
3,822 |
3,138 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
9,101 |
7,672 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,785 |
4,336 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,434 |
4,933 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,598 |
1,339 |
$42K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
79 |
53 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,522 |
1,407 |
$36K |
| D7240 |
Removal of impacted tooth - completely bony |
91 |
30 |
$31K |
| D7250 |
|
155 |
73 |
$29K |
| D9248 |
|
277 |
237 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
189 |
108 |
$13K |
| D9920 |
|
338 |
293 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
209 |
138 |
$11K |
| D0272 |
Bitewings - two radiographic images |
477 |
426 |
$10K |
| D3320 |
|
15 |
12 |
$6K |
| D7311 |
|
159 |
53 |
$6K |
| D1999 |
|
675 |
468 |
$5K |
| D4341 |
|
38 |
13 |
$4K |
| D9222 |
|
56 |
34 |
$2K |
| D4342 |
|
41 |
12 |
$1K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
26 |
12 |
$383.20 |
| D0350 |
|
264 |
219 |
$0.00 |