| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
29,012 |
8,937 |
$1.52M |
| D0330 |
Panoramic radiographic image |
15,230 |
14,827 |
$648K |
| D1120 |
Prophylaxis - child |
12,102 |
11,620 |
$603K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,270 |
3,292 |
$603K |
| D0140 |
Limited oral evaluation - problem focused |
15,485 |
14,965 |
$517K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
955 |
906 |
$420K |
| D7240 |
Removal of impacted tooth - completely bony |
1,820 |
629 |
$378K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,118 |
1,267 |
$360K |
| D1110 |
Prophylaxis - adult |
7,059 |
6,745 |
$324K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,010 |
3,474 |
$303K |
| D0120 |
Periodic oral evaluation - established patient |
13,191 |
12,585 |
$271K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,071 |
8,772 |
$262K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,970 |
3,115 |
$241K |
| D1206 |
Topical application of fluoride varnish |
13,050 |
12,432 |
$201K |
| D0274 |
Bitewings - four radiographic images |
5,719 |
5,504 |
$160K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,681 |
4,311 |
$147K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,585 |
1,115 |
$139K |
| D0210 |
Intraoral - complete series of radiographic images |
3,860 |
3,629 |
$132K |
| D1351 |
Sealant - per tooth |
6,722 |
1,837 |
$113K |
| D9222 |
|
1,184 |
1,141 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
10,198 |
9,663 |
$86K |
| D8670 |
Periodic orthodontic treatment visit |
106 |
95 |
$84K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
44 |
41 |
$61K |
| D3320 |
|
184 |
176 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
860 |
755 |
$51K |
| D4341 |
|
713 |
406 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,775 |
2,681 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,277 |
3,177 |
$43K |
| D7310 |
|
240 |
90 |
$39K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
581 |
271 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,584 |
2,264 |
$38K |
| D2950 |
|
446 |
385 |
$37K |
| D2740 |
Crown - porcelain/ceramic |
88 |
74 |
$37K |
| D2335 |
|
387 |
140 |
$36K |
| D3310 |
|
135 |
117 |
$31K |
| D2331 |
|
609 |
489 |
$29K |
| D9610 |
|
683 |
664 |
$24K |
| D8999 |
|
25 |
25 |
$21K |
| D2330 |
|
385 |
244 |
$18K |
| D0270 |
|
1,984 |
1,917 |
$13K |
| D7230 |
|
60 |
40 |
$10K |
| D8660 |
|
137 |
118 |
$10K |
| D5110 |
|
15 |
14 |
$9K |
| D4910 |
|
148 |
143 |
$9K |
| 70355 |
|
858 |
615 |
$8K |
| D4342 |
|
202 |
135 |
$6K |
| D9420 |
|
85 |
80 |
$5K |
| D0180 |
|
103 |
97 |
$5K |
| D2332 |
|
45 |
40 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
61 |
59 |
$2K |
| D7111 |
|
19 |
12 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
19 |
15 |
$956.17 |
| D0473 |
|
13 |
12 |
$803.53 |
| D2940 |
|
12 |
12 |
$649.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
17 |
12 |
$530.00 |
| 99201 |
|
15 |
14 |
$385.58 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15 |
12 |
$298.41 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
17 |
12 |
$201.30 |
| D0603 |
|
1,611 |
1,587 |
$0.00 |
| D0364 |
|
169 |
163 |
$0.00 |
| D9630 |
|
14 |
12 |
$0.00 |
| D0460 |
|
1,616 |
1,574 |
$0.00 |