| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
17,153 |
4,351 |
$1.01M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,295 |
1,171 |
$817K |
| D7240 |
Removal of impacted tooth - completely bony |
1,478 |
465 |
$372K |
| D0140 |
Limited oral evaluation - problem focused |
11,568 |
9,605 |
$350K |
| D1110 |
Prophylaxis - adult |
7,227 |
6,347 |
$252K |
| D0330 |
Panoramic radiographic image |
6,962 |
5,885 |
$251K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
196 |
161 |
$241K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,898 |
6,108 |
$190K |
| D0210 |
Intraoral - complete series of radiographic images |
4,641 |
3,977 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,395 |
1,804 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,093 |
2,070 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
6,225 |
5,478 |
$106K |
| D0274 |
Bitewings - four radiographic images |
3,641 |
3,176 |
$94K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
204 |
179 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
7,257 |
5,879 |
$63K |
| D1206 |
Topical application of fluoride varnish |
6,574 |
5,707 |
$62K |
| D2330 |
|
1,011 |
659 |
$57K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,483 |
778 |
$53K |
| D1120 |
Prophylaxis - child |
2,397 |
2,141 |
$50K |
| D2331 |
|
695 |
470 |
$50K |
| D1351 |
Sealant - per tooth |
3,198 |
886 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
438 |
348 |
$35K |
| D9222 |
|
1,133 |
835 |
$30K |
| D4910 |
|
1,286 |
1,058 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,347 |
1,085 |
$28K |
| D0340 |
|
973 |
772 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,756 |
1,263 |
$21K |
| D7310 |
|
124 |
39 |
$18K |
| D0272 |
Bitewings - two radiographic images |
936 |
824 |
$16K |
| D0270 |
|
1,353 |
1,177 |
$16K |
| D2332 |
|
153 |
112 |
$13K |
| D5110 |
|
52 |
37 |
$13K |
| D2335 |
|
107 |
86 |
$13K |
| D4342 |
|
841 |
313 |
$10K |
| D4341 |
|
638 |
213 |
$10K |
| D7230 |
|
51 |
27 |
$9K |
| D3310 |
|
20 |
15 |
$2K |
| D2940 |
|
33 |
26 |
$2K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
22 |
14 |
$459.55 |
| D3320 |
|
13 |
12 |
$420.00 |
| D0170 |
|
14 |
13 |
$185.60 |
| D0350 |
|
1,118 |
905 |
$0.00 |
| D8660 |
|
913 |
843 |
$0.00 |
| D0351 |
|
616 |
477 |
$0.00 |
| D2950 |
|
203 |
171 |
$0.00 |
| D0180 |
|
330 |
295 |
$0.00 |
| D0367 |
|
40 |
30 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
121 |
92 |
$0.00 |
| D0801 |
|
173 |
158 |
$0.00 |
| D0470 |
|
90 |
82 |
$0.00 |
| D0364 |
|
78 |
69 |
$0.00 |
| D9997 |
|
39 |
32 |
$0.00 |