| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,696 |
1,362 |
$435K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,669 |
2,238 |
$423K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,955 |
1,375 |
$276K |
| D0210 |
Intraoral - complete series of radiographic images |
5,765 |
4,175 |
$265K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,630 |
4,228 |
$172K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,500 |
1,240 |
$144K |
| D4346 |
|
734 |
638 |
$107K |
| D1110 |
Prophylaxis - adult |
2,231 |
2,065 |
$105K |
| D1351 |
Sealant - per tooth |
3,789 |
621 |
$96K |
| D2332 |
|
745 |
382 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,249 |
2,039 |
$74K |
| D2394 |
|
606 |
357 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,577 |
2,333 |
$57K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
81 |
67 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,464 |
2,263 |
$48K |
| D2335 |
|
289 |
141 |
$47K |
| D1120 |
Prophylaxis - child |
1,597 |
1,471 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
4,446 |
3,884 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,432 |
1,236 |
$43K |
| D0330 |
Panoramic radiographic image |
1,254 |
1,119 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,738 |
3,089 |
$35K |
| D4341 |
|
471 |
87 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,235 |
1,136 |
$25K |
| D7250 |
|
97 |
45 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
280 |
100 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
580 |
476 |
$11K |
| D2331 |
|
91 |
58 |
$9K |
| D7240 |
Removal of impacted tooth - completely bony |
24 |
12 |
$8K |
| D3320 |
|
17 |
12 |
$4K |
| D4342 |
|
50 |
12 |
$3K |
| D1999 |
|
1,751 |
1,484 |
$810.25 |
| D0460 |
|
89 |
58 |
$0.00 |