| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
34,679 |
10,960 |
$2.67M |
| D1110 |
Prophylaxis - adult |
20,268 |
19,980 |
$913K |
| D0140 |
Limited oral evaluation - problem focused |
27,046 |
25,910 |
$836K |
| D0330 |
Panoramic radiographic image |
13,229 |
12,912 |
$650K |
| D7240 |
Removal of impacted tooth - completely bony |
2,821 |
1,178 |
$618K |
| D5110 |
|
706 |
684 |
$611K |
| D1206 |
Topical application of fluoride varnish |
19,117 |
18,889 |
$486K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,452 |
6,122 |
$482K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,469 |
5,132 |
$469K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,554 |
15,207 |
$466K |
| D0274 |
Bitewings - four radiographic images |
15,753 |
15,556 |
$464K |
| D0120 |
Periodic oral evaluation - established patient |
15,997 |
15,776 |
$451K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
833 |
777 |
$403K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,725 |
2,362 |
$394K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,666 |
3,826 |
$386K |
| D2331 |
|
4,138 |
3,114 |
$372K |
| D4341 |
|
2,739 |
1,496 |
$304K |
| D2330 |
|
4,512 |
3,252 |
$299K |
| D1120 |
Prophylaxis - child |
8,136 |
8,067 |
$263K |
| D5120 |
|
248 |
245 |
$240K |
| D3310 |
|
607 |
504 |
$233K |
| D2140 |
|
3,595 |
2,819 |
$231K |
| D0220 |
Intraoral - periapical first radiographic image |
19,645 |
18,683 |
$229K |
| D1351 |
Sealant - per tooth |
7,219 |
2,279 |
$223K |
| D3320 |
|
486 |
458 |
$219K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
170 |
164 |
$217K |
| D2335 |
|
1,661 |
1,318 |
$191K |
| D0210 |
Intraoral - complete series of radiographic images |
5,618 |
5,306 |
$186K |
| D2332 |
|
1,603 |
1,277 |
$180K |
| D2160 |
|
1,694 |
1,528 |
$174K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,740 |
1,526 |
$151K |
| D9222 |
|
1,519 |
1,446 |
$144K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,239 |
8,550 |
$131K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,475 |
782 |
$130K |
| D4342 |
|
1,168 |
649 |
$120K |
| D0272 |
Bitewings - two radiographic images |
4,136 |
4,097 |
$114K |
| D4910 |
|
2,488 |
2,313 |
$103K |
| D2740 |
Crown - porcelain/ceramic |
536 |
421 |
$96K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
1,320 |
1,029 |
$84K |
| D7230 |
|
712 |
397 |
$83K |
| D5214 |
|
55 |
53 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,968 |
3,788 |
$57K |
| D2950 |
|
408 |
358 |
$53K |
| D2161 |
|
241 |
222 |
$33K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
332 |
317 |
$32K |
| D7220 |
|
357 |
187 |
$30K |
| D2394 |
|
290 |
261 |
$29K |
| D0270 |
|
2,289 |
2,226 |
$23K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
273 |
258 |
$14K |
| D5213 |
|
13 |
12 |
$14K |
| D8670 |
Periodic orthodontic treatment visit |
65 |
65 |
$12K |
| D1330 |
|
260 |
253 |
$9K |
| D3348 |
|
12 |
12 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
34 |
25 |
$7K |
| D2940 |
|
113 |
104 |
$6K |
| D0240 |
|
170 |
129 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
85 |
83 |
$4K |
| D1310 |
|
90 |
90 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
28 |
27 |
$3K |
| D0273 |
|
28 |
28 |
$1K |
| D0180 |
|
155 |
150 |
$962.58 |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
37 |
26 |
$951.81 |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
41 |
30 |
$812.83 |
| 70486 |
|
15 |
12 |
$740.02 |
| D0470 |
|
187 |
185 |
$486.63 |
| D9420 |
|
73 |
53 |
$380.66 |
| D0340 |
|
257 |
257 |
$348.52 |
| D0350 |
|
257 |
257 |
$128.00 |
| D1353 |
|
33 |
14 |
$0.00 |
| D0383 |
|
12 |
12 |
$0.00 |