| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,726 |
1,832 |
$350K |
| D1110 |
Prophylaxis - adult |
2,358 |
2,318 |
$65K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
227 |
189 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,386 |
983 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
3,455 |
3,364 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
3,135 |
3,113 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
957 |
924 |
$35K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
102 |
92 |
$26K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
627 |
325 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
4,873 |
4,684 |
$24K |
| D7230 |
|
124 |
65 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,903 |
1,864 |
$23K |
| D1120 |
Prophylaxis - child |
1,474 |
1,471 |
$20K |
| D9310 |
|
1,097 |
1,081 |
$19K |
| D2954 |
|
229 |
183 |
$17K |
| D9222 |
|
415 |
353 |
$15K |
| D0330 |
Panoramic radiographic image |
408 |
404 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
433 |
130 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,073 |
1,073 |
$12K |
| D0274 |
Bitewings - four radiographic images |
995 |
978 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
487 |
387 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,677 |
2,465 |
$7K |
| D0272 |
Bitewings - two radiographic images |
798 |
798 |
$6K |
| D0603 |
|
934 |
934 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
123 |
107 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
136 |
105 |
$3K |
| D2950 |
|
99 |
68 |
$3K |
| D1351 |
Sealant - per tooth |
379 |
134 |
$3K |
| D3320 |
|
15 |
13 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
478 |
439 |
$2K |
| D9920 |
|
340 |
336 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
77 |
64 |
$1K |
| D4910 |
|
12 |
12 |
$768.00 |
| D9430 |
|
52 |
51 |
$671.00 |
| D2332 |
|
16 |
13 |
$336.00 |
| D0270 |
|
116 |
115 |
$264.00 |
| D1206 |
Topical application of fluoride varnish |
436 |
432 |
$226.00 |
| D1999 |
|
29 |
29 |
$0.00 |