| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,390 |
3,706 |
$1.22M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,420 |
3,475 |
$609K |
| D0210 |
Intraoral - complete series of radiographic images |
9,762 |
7,022 |
$440K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,969 |
2,319 |
$402K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,242 |
7,103 |
$275K |
| D1110 |
Prophylaxis - adult |
4,753 |
4,154 |
$192K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,748 |
1,565 |
$176K |
| D7250 |
|
965 |
421 |
$176K |
| D0274 |
Bitewings - four radiographic images |
5,750 |
4,962 |
$167K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
310 |
253 |
$166K |
| D4341 |
|
1,967 |
348 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
6,006 |
5,211 |
$119K |
| D0140 |
Limited oral evaluation - problem focused |
3,720 |
3,122 |
$112K |
| D2335 |
|
731 |
357 |
$96K |
| D1351 |
Sealant - per tooth |
4,311 |
621 |
$90K |
| D2332 |
|
923 |
416 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
9,712 |
8,093 |
$84K |
| D4346 |
|
606 |
498 |
$84K |
| D2394 |
|
971 |
520 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,176 |
456 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,402 |
6,275 |
$71K |
| D0330 |
Panoramic radiographic image |
2,026 |
1,674 |
$65K |
| D1120 |
Prophylaxis - child |
2,229 |
1,969 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,348 |
2,063 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,810 |
1,588 |
$33K |
| D2331 |
|
306 |
168 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,573 |
1,370 |
$29K |
| D3320 |
|
61 |
44 |
$23K |
| D7240 |
Removal of impacted tooth - completely bony |
106 |
37 |
$23K |
| D4910 |
|
228 |
184 |
$20K |
| D4342 |
|
492 |
90 |
$20K |
| D7220 |
|
47 |
25 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
530 |
427 |
$7K |
| D2330 |
|
44 |
26 |
$3K |
| D1999 |
|
2,647 |
2,243 |
$1K |