| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
29,528 |
7,909 |
$1.59M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
9,214 |
4,033 |
$850K |
| D7240 |
Removal of impacted tooth - completely bony |
2,855 |
1,514 |
$648K |
| D0140 |
Limited oral evaluation - problem focused |
18,614 |
18,308 |
$599K |
| D7230 |
|
3,141 |
2,134 |
$546K |
| D9420 |
|
2,262 |
2,216 |
$327K |
| D9243 |
|
3,945 |
1,349 |
$284K |
| D1110 |
Prophylaxis - adult |
5,589 |
5,570 |
$174K |
| D0330 |
Panoramic radiographic image |
4,445 |
4,424 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,198 |
1,063 |
$145K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,395 |
798 |
$124K |
| D9239 |
|
1,452 |
1,350 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
4,228 |
4,213 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,801 |
2,777 |
$75K |
| D2330 |
|
808 |
448 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
1,477 |
1,449 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,608 |
3,505 |
$40K |
| D2331 |
|
424 |
256 |
$31K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
444 |
443 |
$23K |
| D0274 |
Bitewings - four radiographic images |
972 |
970 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,537 |
1,618 |
$19K |
| D2332 |
|
153 |
81 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
55 |
12 |
$12K |
| D1354 |
|
906 |
359 |
$11K |
| 20553 |
|
282 |
277 |
$10K |
| D7220 |
|
73 |
56 |
$8K |
| 99223 |
Prolong inpt eval add15 m |
75 |
75 |
$7K |
| D1206 |
Topical application of fluoride varnish |
322 |
317 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
55 |
41 |
$7K |
| 70355 |
|
742 |
735 |
$6K |
| D7310 |
|
40 |
13 |
$4K |
| D4355 |
|
60 |
60 |
$3K |
| D1120 |
Prophylaxis - child |
90 |
88 |
$3K |
| D7473 |
|
18 |
12 |
$3K |
| D7250 |
|
65 |
18 |
$3K |
| D7510 |
|
14 |
12 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28 |
28 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$978.60 |
| D0240 |
|
43 |
24 |
$925.32 |
| D2140 |
|
27 |
13 |
$909.03 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
12 |
$848.36 |
| D9310 |
|
15 |
15 |
$480.36 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
222 |
218 |
$228.00 |
| D9440 |
|
68 |
63 |
$0.00 |