| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,003 |
2,088 |
$446K |
| D7240 |
Removal of impacted tooth - completely bony |
2,505 |
789 |
$283K |
| D1351 |
Sealant - per tooth |
9,292 |
1,466 |
$202K |
| D0330 |
Panoramic radiographic image |
5,119 |
4,875 |
$195K |
| D1120 |
Prophylaxis - child |
3,542 |
3,456 |
$153K |
| D0140 |
Limited oral evaluation - problem focused |
4,560 |
4,273 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,612 |
4,432 |
$136K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,418 |
7,419 |
$130K |
| D1206 |
Topical application of fluoride varnish |
3,545 |
3,457 |
$124K |
| D0274 |
Bitewings - four radiographic images |
5,336 |
5,117 |
$120K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
36 |
32 |
$97K |
| D0210 |
Intraoral - complete series of radiographic images |
1,725 |
1,637 |
$93K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,049 |
937 |
$78K |
| D8660 |
|
1,703 |
1,616 |
$77K |
| D9310 |
|
1,207 |
1,136 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
4,763 |
4,545 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,267 |
597 |
$65K |
| D7220 |
|
537 |
252 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,251 |
173 |
$49K |
| D9222 |
|
1,034 |
941 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
754 |
358 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,275 |
1,222 |
$28K |
| D9248 |
|
224 |
214 |
$19K |
| D0470 |
|
796 |
753 |
$19K |
| D0340 |
|
396 |
378 |
$15K |
| D0350 |
|
774 |
735 |
$14K |
| D0240 |
|
1,044 |
1,020 |
$14K |
| D7311 |
|
365 |
120 |
$14K |
| D1110 |
Prophylaxis - adult |
690 |
636 |
$14K |
| D1353 |
|
770 |
155 |
$12K |
| D0999 |
Unspecified diagnostic procedure, by report |
212 |
212 |
$6K |
| D0365 |
|
45 |
43 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
219 |
219 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
335 |
299 |
$5K |
| D7241 |
|
41 |
16 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
12 |
$1K |
| D0170 |
|
25 |
25 |
$461.00 |
| D0272 |
Bitewings - two radiographic images |
28 |
23 |
$381.21 |
| D0603 |
|
72 |
72 |
$360.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
22 |
19 |
$174.08 |
| D0601 |
|
24 |
19 |
$85.00 |
| D0602 |
|
13 |
13 |
$65.00 |