| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
81,375 |
33,293 |
$273K |
| D5110 |
|
2,033 |
1,964 |
$251K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
303 |
301 |
$141K |
| D0191 |
|
102,060 |
98,792 |
$122K |
| D1351 |
Sealant - per tooth |
135,283 |
39,508 |
$115K |
| D1206 |
Topical application of fluoride varnish |
341,143 |
329,307 |
$114K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
63,256 |
22,355 |
$87K |
| D5120 |
|
773 |
750 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
107,390 |
103,264 |
$75K |
| D0602 |
|
116,546 |
111,810 |
$54K |
| D0603 |
|
159,659 |
151,814 |
$44K |
| D9310 |
|
29,537 |
29,053 |
$36K |
| D1120 |
Prophylaxis - child |
142,702 |
138,019 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
140,809 |
135,934 |
$31K |
| D1355 |
|
4,774 |
1,396 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
92,975 |
60,724 |
$28K |
| D2940 |
|
2,735 |
1,750 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45,250 |
42,260 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
184,206 |
178,036 |
$22K |
| D0330 |
Panoramic radiographic image |
69,735 |
67,721 |
$18K |
| D1110 |
Prophylaxis - adult |
119,119 |
116,338 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65,885 |
42,964 |
$13K |
| D7230 |
|
626 |
419 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
191,978 |
177,067 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
51,093 |
49,688 |
$12K |
| D0601 |
|
59,882 |
56,867 |
$11K |
| D0274 |
Bitewings - four radiographic images |
132,908 |
129,125 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20,842 |
8,007 |
$8K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
15,726 |
4,356 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
248,528 |
109,638 |
$7K |
| D0240 |
|
54,540 |
28,378 |
$6K |
| D0272 |
Bitewings - two radiographic images |
62,255 |
60,417 |
$5K |
| D7220 |
|
856 |
538 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14,638 |
11,547 |
$5K |
| D4341 |
|
15,579 |
8,613 |
$4K |
| D9610 |
|
4,430 |
4,345 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,894 |
17,450 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
4,946 |
2,733 |
$2K |
| D9222 |
|
692 |
682 |
$2K |
| D7250 |
|
1,704 |
780 |
$2K |
| D8660 |
|
17,844 |
12,744 |
$2K |
| D0270 |
|
20,468 |
19,939 |
$2K |
| D1354 |
|
52,513 |
14,141 |
$1K |
| D4910 |
|
28,753 |
28,247 |
$939.99 |
| D9996 |
|
2,984 |
2,926 |
$932.52 |
| D7240 |
Removal of impacted tooth - completely bony |
6,160 |
2,422 |
$742.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,036 |
2,588 |
$625.20 |
| 97535 |
Self-care/home management training, each 15 minutes |
24 |
23 |
$526.90 |
| D2394 |
|
1,943 |
1,347 |
$484.35 |
| D1320 |
|
13,223 |
12,737 |
$306.02 |
| D0145 |
Oral evaluation for a patient under three years of age |
3,208 |
3,168 |
$267.24 |
| D2332 |
|
2,267 |
1,509 |
$198.00 |
| D4346 |
|
4,434 |
4,396 |
$191.33 |
| D3320 |
|
58 |
52 |
$169.14 |
| D4342 |
|
8,499 |
4,956 |
$142.11 |
| D2330 |
|
1,524 |
1,041 |
$117.84 |
| D2331 |
|
2,875 |
1,932 |
$106.74 |
| D2335 |
|
1,682 |
1,050 |
$82.70 |
| D0170 |
|
811 |
780 |
$54.14 |
| D4355 |
|
3,895 |
3,819 |
$49.11 |
| D0350 |
|
3,267 |
3,214 |
$21.19 |
| D5410 |
|
2,380 |
2,151 |
$18.55 |
| D5411 |
|
2,195 |
1,975 |
$18.55 |
| D1330 |
|
232,404 |
219,922 |
$10.00 |
| D1310 |
|
101,452 |
96,800 |
$0.00 |
| D2931 |
|
959 |
839 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
4,053 |
3,829 |
$0.00 |
| D5730 |
|
663 |
640 |
$0.00 |
| D9248 |
|
1,250 |
1,197 |
$0.00 |
| D9450 |
|
202 |
201 |
$0.00 |
| D3120 |
|
900 |
755 |
$0.00 |
| D1352 |
|
1,719 |
923 |
$0.00 |
| D5130 |
|
262 |
255 |
$0.00 |
| D2160 |
|
615 |
422 |
$0.00 |
| D5999 |
|
569 |
428 |
$0.00 |
| D9215 |
|
103 |
71 |
$0.00 |
| D9920 |
|
327 |
316 |
$0.00 |
| D0470 |
|
121 |
121 |
$0.00 |
| D9420 |
|
203 |
198 |
$0.00 |
| D0801 |
|
659 |
620 |
$0.00 |
| D7111 |
|
123 |
79 |
$0.00 |
| D5751 |
|
12 |
12 |
$0.00 |
| D3240 |
|
48 |
41 |
$0.00 |
| D5212 |
|
80 |
80 |
$0.00 |
| D7311 |
|
61 |
36 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
14 |
$0.00 |
| D4211 |
|
15 |
13 |
$0.00 |
| D0273 |
|
26 |
26 |
$0.00 |
| D8030 |
|
21 |
21 |
$0.00 |
| D5750 |
|
97 |
97 |
$0.00 |
| D5851 |
|
211 |
199 |
$0.00 |
| D0709 |
|
105 |
103 |
$0.00 |
| D0460 |
|
937 |
900 |
$0.00 |
| D9410 |
|
14 |
14 |
$0.00 |
| D4921 |
|
3,170 |
1,648 |
$0.00 |
| D0431 |
|
95 |
84 |
$0.00 |
| D2140 |
|
680 |
479 |
$0.00 |
| D5731 |
|
404 |
392 |
$0.00 |
| D0160 |
|
15 |
15 |
$0.00 |
| D9990 |
|
14 |
12 |
$0.00 |
| D0180 |
|
1,094 |
1,091 |
$0.00 |
| D5850 |
|
447 |
419 |
$0.00 |
| D1555 |
|
12 |
12 |
$0.00 |
| D1510 |
|
212 |
166 |
$0.00 |
| D5140 |
|
167 |
154 |
$0.00 |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
253 |
253 |
$0.00 |
| D1321 |
|
25 |
25 |
$0.00 |
| D0340 |
|
305 |
305 |
$0.00 |
| D9430 |
|
246 |
219 |
$0.00 |
| D2941 |
|
196 |
115 |
$0.00 |
| D2934 |
|
67 |
24 |
$0.00 |
| D5211 |
|
56 |
55 |
$0.00 |
| D5422 |
|
14 |
14 |
$0.00 |
| D9971 |
|
23 |
13 |
$0.00 |