| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17,044 |
7,006 |
$2.73M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
3,025 |
2,725 |
$2.23M |
| D3320 |
|
1,145 |
1,002 |
$646K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,400 |
11,214 |
$573K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,196 |
1,778 |
$435K |
| D7230 |
|
1,070 |
649 |
$243K |
| D2740 |
Crown - porcelain/ceramic |
456 |
354 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
5,693 |
5,564 |
$166K |
| D0330 |
Panoramic radiographic image |
3,809 |
3,733 |
$130K |
| D1110 |
Prophylaxis - adult |
2,519 |
2,469 |
$121K |
| D1120 |
Prophylaxis - child |
3,446 |
3,379 |
$97K |
| D7240 |
Removal of impacted tooth - completely bony |
325 |
183 |
$95K |
| D3310 |
|
191 |
149 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,567 |
3,480 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,447 |
958 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
3,033 |
2,962 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,596 |
978 |
$59K |
| D1351 |
Sealant - per tooth |
2,104 |
477 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
6,080 |
5,807 |
$48K |
| D9310 |
|
826 |
820 |
$41K |
| D0274 |
Bitewings - four radiographic images |
2,811 |
2,762 |
$35K |
| D7220 |
|
150 |
102 |
$31K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
188 |
57 |
$29K |
| D1999 |
|
3,609 |
3,496 |
$19K |
| D2952 |
|
239 |
192 |
$16K |
| D9999 |
Unspecified adjunctive procedure, by report |
140 |
134 |
$15K |
| D4341 |
|
466 |
159 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,097 |
3,898 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
52 |
14 |
$9K |
| D9222 |
|
57 |
57 |
$9K |
| D7250 |
|
68 |
32 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
151 |
132 |
$6K |
| D9610 |
|
60 |
15 |
$3K |
| D9110 |
|
397 |
357 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
31 |
31 |
$2K |
| D0272 |
Bitewings - two radiographic images |
239 |
238 |
$2K |
| D0270 |
|
731 |
701 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
33 |
$1K |
| D0160 |
|
47 |
45 |
$950.00 |
| D0140 |
Limited oral evaluation - problem focused |
142 |
141 |
$665.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$590.00 |
| D2330 |
|
28 |
12 |
$310.00 |
| D1330 |
|
14 |
14 |
$0.00 |