| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,569 |
2,113 |
$390K |
| D7240 |
Removal of impacted tooth - completely bony |
2,059 |
652 |
$227K |
| D1120 |
Prophylaxis - child |
5,348 |
5,175 |
$227K |
| D0330 |
Panoramic radiographic image |
6,333 |
6,048 |
$223K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,836 |
10,902 |
$212K |
| D1351 |
Sealant - per tooth |
9,444 |
1,400 |
$206K |
| D0274 |
Bitewings - four radiographic images |
9,000 |
8,647 |
$201K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,163 |
4,963 |
$152K |
| D0140 |
Limited oral evaluation - problem focused |
4,862 |
4,604 |
$151K |
| D1206 |
Topical application of fluoride varnish |
3,725 |
3,613 |
$128K |
| D8660 |
|
2,230 |
2,095 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
5,301 |
5,072 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,214 |
533 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,788 |
2,680 |
$58K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,009 |
830 |
$51K |
| D0340 |
|
1,199 |
1,148 |
$45K |
| D9222 |
|
1,030 |
873 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
779 |
744 |
$42K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
14 |
13 |
$34K |
| D9310 |
|
531 |
491 |
$29K |
| D0470 |
|
1,239 |
1,179 |
$28K |
| D7220 |
|
218 |
112 |
$24K |
| D0240 |
|
1,763 |
1,713 |
$24K |
| D1110 |
Prophylaxis - adult |
1,031 |
969 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
587 |
271 |
$22K |
| D0350 |
|
1,235 |
1,181 |
$22K |
| D1353 |
|
849 |
135 |
$13K |
| D0272 |
Bitewings - two radiographic images |
723 |
664 |
$11K |
| D0999 |
Unspecified diagnostic procedure, by report |
330 |
330 |
$10K |
| D9999 |
Unspecified adjunctive procedure, by report |
292 |
292 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
868 |
853 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
161 |
42 |
$7K |
| D9248 |
|
49 |
45 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
216 |
190 |
$3K |
| D7311 |
|
131 |
35 |
$3K |
| D1999 |
|
85 |
85 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
12 |
$1K |
| D0603 |
|
93 |
90 |
$299.00 |
| D0601 |
|
16 |
16 |
$16.00 |