| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,887 |
2,306 |
$1.54M |
| D7240 |
Removal of impacted tooth - completely bony |
3,611 |
1,309 |
$1.16M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,594 |
4,901 |
$1.12M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,668 |
2,924 |
$654K |
| D1110 |
Prophylaxis - adult |
10,777 |
10,723 |
$648K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,083 |
2,058 |
$583K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
612 |
567 |
$499K |
| D8670 |
Periodic orthodontic treatment visit |
1,532 |
1,529 |
$462K |
| D0120 |
Periodic oral evaluation - established patient |
13,650 |
13,584 |
$427K |
| D9222 |
|
2,233 |
2,218 |
$333K |
| D1351 |
Sealant - per tooth |
7,498 |
1,659 |
$303K |
| D1206 |
Topical application of fluoride varnish |
11,291 |
11,235 |
$265K |
| D1330 |
|
15,024 |
14,953 |
$262K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,581 |
4,577 |
$243K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,297 |
1,649 |
$243K |
| D0140 |
Limited oral evaluation - problem focused |
5,314 |
5,259 |
$238K |
| D7230 |
|
817 |
515 |
$234K |
| D1310 |
|
14,055 |
14,000 |
$233K |
| D1120 |
Prophylaxis - child |
5,092 |
5,078 |
$225K |
| D0274 |
Bitewings - four radiographic images |
6,070 |
6,049 |
$213K |
| D7310 |
|
725 |
274 |
$171K |
| D0330 |
Panoramic radiographic image |
3,010 |
3,003 |
$159K |
| D2740 |
Crown - porcelain/ceramic |
241 |
175 |
$139K |
| D0210 |
Intraoral - complete series of radiographic images |
1,881 |
1,878 |
$135K |
| D2394 |
|
803 |
554 |
$125K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
115 |
112 |
$118K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
635 |
417 |
$108K |
| D0272 |
Bitewings - two radiographic images |
3,432 |
3,423 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
7,796 |
7,621 |
$97K |
| D2332 |
|
683 |
365 |
$90K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,613 |
1,484 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
599 |
393 |
$73K |
| D3310 |
|
80 |
55 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,497 |
2,404 |
$40K |
| D3320 |
|
66 |
61 |
$33K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
304 |
190 |
$28K |
| D8660 |
|
149 |
148 |
$28K |
| D9920 |
|
242 |
232 |
$22K |
| D0603 |
|
4,825 |
4,789 |
$20K |
| D0270 |
|
1,228 |
1,226 |
$16K |
| D2335 |
|
107 |
53 |
$13K |
| D2331 |
|
82 |
60 |
$9K |
| D9110 |
|
218 |
216 |
$8K |
| D0601 |
|
858 |
858 |
$5K |
| D2954 |
|
36 |
25 |
$5K |
| D1354 |
|
233 |
133 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
76 |
76 |
$3K |
| D0602 |
|
150 |
149 |
$1K |
| D1320 |
|
26 |
25 |
$455.43 |
| D1999 |
|
28 |
28 |
$182.00 |
| D3120 |
|
15 |
12 |
$131.65 |