| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,803 |
817 |
$487K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,303 |
1,781 |
$445K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,715 |
739 |
$269K |
| D1110 |
Prophylaxis - adult |
3,257 |
3,197 |
$147K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,024 |
392 |
$141K |
| D2394 |
|
733 |
355 |
$126K |
| D1120 |
Prophylaxis - child |
4,182 |
4,132 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
5,820 |
5,726 |
$120K |
| D1206 |
Topical application of fluoride varnish |
7,226 |
7,106 |
$117K |
| D0274 |
Bitewings - four radiographic images |
2,480 |
2,446 |
$74K |
| D0330 |
Panoramic radiographic image |
1,517 |
1,505 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,599 |
2,415 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,640 |
1,592 |
$50K |
| D5110 |
|
63 |
63 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,411 |
1,366 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,617 |
2,588 |
$39K |
| D1351 |
Sealant - per tooth |
1,205 |
442 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
423 |
245 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,219 |
1,199 |
$22K |
| D7240 |
Removal of impacted tooth - completely bony |
91 |
29 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,714 |
1,490 |
$20K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
150 |
40 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
269 |
256 |
$17K |
| D2335 |
|
123 |
52 |
$15K |
| D5120 |
|
12 |
12 |
$9K |
| D7310 |
|
30 |
12 |
$4K |
| D2332 |
|
22 |
14 |
$2K |
| D0603 |
|
171 |
171 |
$1K |
| D0602 |
|
88 |
88 |
$764.45 |