| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9243 |
|
13,998 |
2,509 |
$1.53M |
| D1110 |
Prophylaxis - adult |
24,773 |
23,499 |
$1.18M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,386 |
1,821 |
$1.01M |
| D0120 |
Periodic oral evaluation - established patient |
29,644 |
29,166 |
$932K |
| D1206 |
Topical application of fluoride varnish |
23,558 |
23,088 |
$603K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,360 |
5,165 |
$588K |
| D0140 |
Limited oral evaluation - problem focused |
14,936 |
14,296 |
$579K |
| D0274 |
Bitewings - four radiographic images |
14,973 |
14,749 |
$552K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,716 |
1,026 |
$475K |
| D1120 |
Prophylaxis - child |
13,121 |
12,878 |
$462K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,960 |
2,569 |
$384K |
| D9239 |
|
2,724 |
2,478 |
$359K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,262 |
3,924 |
$342K |
| D1354 |
|
10,330 |
2,906 |
$339K |
| D0330 |
Panoramic radiographic image |
4,764 |
4,687 |
$311K |
| D1351 |
Sealant - per tooth |
7,841 |
2,654 |
$227K |
| D0220 |
Intraoral - periapical first radiographic image |
12,937 |
12,420 |
$190K |
| D2331 |
|
1,874 |
1,204 |
$145K |
| D0272 |
Bitewings - two radiographic images |
4,692 |
4,616 |
$131K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,655 |
1,116 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,028 |
3,948 |
$122K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,585 |
4,756 |
$89K |
| D2330 |
|
1,368 |
907 |
$79K |
| D2160 |
|
656 |
534 |
$69K |
| D7230 |
|
321 |
142 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,478 |
3,269 |
$67K |
| D2332 |
|
522 |
374 |
$56K |
| D0350 |
|
681 |
679 |
$53K |
| D2140 |
|
887 |
658 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
799 |
626 |
$50K |
| D2335 |
|
458 |
347 |
$47K |
| D1330 |
|
1,181 |
1,172 |
$43K |
| D0240 |
|
1,200 |
693 |
$41K |
| D1310 |
|
784 |
774 |
$30K |
| D7251 |
|
78 |
39 |
$25K |
| D2161 |
|
62 |
53 |
$7K |
| D7240 |
Removal of impacted tooth - completely bony |
28 |
12 |
$7K |
| D4910 |
|
36 |
36 |
$3K |
| D9920 |
|
121 |
103 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
26 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
38 |
$2K |
| D2394 |
|
14 |
12 |
$2K |
| D0365 |
|
333 |
324 |
$2K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
15 |
13 |
$887.04 |
| D4341 |
|
63 |
30 |
$532.95 |
| D0270 |
|
16 |
16 |
$209.51 |
| D7922 |
|
2,191 |
718 |
$198.98 |
| D9248 |
|
17 |
12 |
$179.52 |
| D3120 |
|
346 |
233 |
$164.56 |
| D9985 |
|
104 |
95 |
$91.40 |
| D9996 |
|
324 |
315 |
$0.00 |
| D9219 |
|
132 |
131 |
$0.00 |
| D1999 |
|
66 |
57 |
$0.00 |
| D9995 |
|
126 |
124 |
$0.00 |