| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
4,824 |
1,595 |
$235K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,811 |
972 |
$196K |
| D0210 |
Intraoral - complete series of radiographic images |
3,112 |
2,704 |
$138K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,670 |
1,240 |
$115K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,689 |
952 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,823 |
2,527 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,461 |
770 |
$52K |
| D2335 |
|
605 |
339 |
$44K |
| D1110 |
Prophylaxis - adult |
1,378 |
1,271 |
$37K |
| D2332 |
|
577 |
331 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,458 |
1,289 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
2,436 |
2,222 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,541 |
1,362 |
$29K |
| D2394 |
|
555 |
366 |
$28K |
| D7250 |
|
182 |
119 |
$21K |
| D0330 |
Panoramic radiographic image |
866 |
733 |
$17K |
| D1351 |
Sealant - per tooth |
1,314 |
161 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,940 |
1,716 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
889 |
812 |
$9K |
| D4341 |
|
114 |
25 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,930 |
718 |
$7K |
| D1120 |
Prophylaxis - child |
423 |
389 |
$6K |
| D2331 |
|
122 |
83 |
$5K |
| D4346 |
|
55 |
42 |
$4K |
| D2330 |
|
115 |
67 |
$3K |
| D5110 |
|
42 |
41 |
$2K |
| D0272 |
Bitewings - two radiographic images |
195 |
171 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
128 |
114 |
$1K |
| D7240 |
Removal of impacted tooth - completely bony |
90 |
34 |
$1K |
| D4910 |
|
13 |
13 |
$972.90 |
| D0270 |
|
47 |
44 |
$700.32 |
| D5212 |
|
16 |
14 |
$0.00 |