| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
11,956 |
6,083 |
$602K |
| D8670 |
Periodic orthodontic treatment visit |
1,242 |
1,218 |
$366K |
| D9222 |
|
277 |
275 |
$299K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
218 |
203 |
$295K |
| 99070 |
|
311 |
251 |
$275K |
| D0140 |
Limited oral evaluation - problem focused |
5,472 |
5,356 |
$163K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
418 |
391 |
$156K |
| D1110 |
Prophylaxis - adult |
4,868 |
4,824 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
6,094 |
6,041 |
$114K |
| D8660 |
|
1,042 |
1,009 |
$100K |
| D1120 |
Prophylaxis - child |
3,488 |
3,473 |
$88K |
| D1206 |
Topical application of fluoride varnish |
5,095 |
5,073 |
$86K |
| D1351 |
Sealant - per tooth |
3,165 |
704 |
$75K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,408 |
531 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,364 |
1,092 |
$71K |
| D0330 |
Panoramic radiographic image |
2,152 |
2,139 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
1,688 |
1,664 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,402 |
3,382 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,158 |
862 |
$50K |
| D7240 |
Removal of impacted tooth - completely bony |
308 |
119 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,923 |
1,913 |
$48K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
101 |
98 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
5,480 |
5,295 |
$40K |
| D5110 |
|
80 |
80 |
$38K |
| D1310 |
|
4,618 |
4,592 |
$37K |
| D1330 |
|
3,429 |
3,406 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,344 |
1,341 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,682 |
1,629 |
$18K |
| D2331 |
|
314 |
247 |
$16K |
| D8680 |
|
78 |
77 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
238 |
215 |
$13K |
| D5120 |
|
26 |
26 |
$13K |
| D0270 |
|
1,567 |
1,545 |
$12K |
| D2330 |
|
269 |
188 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
289 |
267 |
$11K |
| D0603 |
|
1,587 |
1,578 |
$9K |
| D2332 |
|
135 |
116 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
879 |
693 |
$7K |
| D4342 |
|
156 |
121 |
$6K |
| D2335 |
|
90 |
80 |
$6K |
| D5214 |
|
13 |
13 |
$5K |
| D4341 |
|
77 |
47 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
101 |
90 |
$5K |
| D3310 |
|
16 |
13 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
41 |
14 |
$3K |
| D0602 |
|
338 |
335 |
$2K |
| D9110 |
|
36 |
32 |
$984.00 |
| D0601 |
|
132 |
132 |
$945.04 |
| D2140 |
|
14 |
12 |
$513.00 |
| D1354 |
|
28 |
12 |
$269.90 |
| D0240 |
|
21 |
15 |
$268.19 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$223.24 |
| D0180 |
|
95 |
94 |
$0.00 |