| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,950 |
2,686 |
$1.28M |
| D7240 |
Removal of impacted tooth - completely bony |
1,092 |
386 |
$322K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,660 |
1,667 |
$197K |
| D1110 |
Prophylaxis - adult |
3,967 |
3,731 |
$176K |
| D0140 |
Limited oral evaluation - problem focused |
4,944 |
4,547 |
$174K |
| D7250 |
|
702 |
206 |
$141K |
| D0330 |
Panoramic radiographic image |
3,154 |
2,869 |
$139K |
| D0210 |
Intraoral - complete series of radiographic images |
2,990 |
2,427 |
$133K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,037 |
1,280 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,315 |
3,031 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
5,240 |
4,959 |
$110K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,045 |
700 |
$94K |
| D1206 |
Topical application of fluoride varnish |
4,628 |
4,332 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,489 |
2,289 |
$72K |
| D1120 |
Prophylaxis - child |
2,381 |
2,246 |
$70K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
114 |
93 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
3,585 |
3,234 |
$40K |
| D9248 |
|
700 |
604 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
327 |
131 |
$25K |
| D2331 |
|
238 |
144 |
$22K |
| D0272 |
Bitewings - two radiographic images |
666 |
630 |
$13K |
| D1351 |
Sealant - per tooth |
429 |
56 |
$11K |
| D5110 |
|
16 |
12 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
874 |
470 |
$6K |
| D7230 |
|
22 |
14 |
$6K |
| D2332 |
|
36 |
27 |
$4K |
| D2931 |
|
20 |
13 |
$1K |
| D1999 |
|
532 |
401 |
$344.72 |
| D1208 |
Topical application of fluoride, excluding varnish |
97 |
97 |
$111.95 |
| D2949 |
|
16 |
13 |
$0.00 |