| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,654 |
1,605 |
$1.51M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,199 |
1,465 |
$478K |
| D2740 |
Crown - porcelain/ceramic |
641 |
465 |
$370K |
| D1110 |
Prophylaxis - adult |
4,968 |
4,455 |
$365K |
| D0140 |
Limited oral evaluation - problem focused |
5,803 |
5,458 |
$347K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,716 |
5,180 |
$333K |
| D0220 |
Intraoral - periapical first radiographic image |
11,302 |
10,467 |
$248K |
| D5110 |
|
241 |
217 |
$237K |
| D0330 |
Panoramic radiographic image |
2,270 |
2,033 |
$194K |
| D0274 |
Bitewings - four radiographic images |
3,575 |
3,234 |
$185K |
| D2950 |
|
966 |
699 |
$161K |
| D9239 |
|
1,164 |
1,011 |
$158K |
| D0210 |
Intraoral - complete series of radiographic images |
1,666 |
1,505 |
$130K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,620 |
5,007 |
$120K |
| D9243 |
|
469 |
392 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
2,242 |
2,021 |
$92K |
| D1206 |
Topical application of fluoride varnish |
3,469 |
3,110 |
$86K |
| D5120 |
|
74 |
66 |
$74K |
| D9610 |
|
853 |
788 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
402 |
98 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
287 |
139 |
$43K |
| D7240 |
Removal of impacted tooth - completely bony |
91 |
27 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
871 |
789 |
$23K |
| D0270 |
|
1,025 |
934 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
167 |
94 |
$18K |
| D7230 |
|
49 |
27 |
$17K |
| D1120 |
Prophylaxis - child |
244 |
227 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
266 |
230 |
$13K |
| D2331 |
|
35 |
18 |
$3K |
| D4910 |
|
31 |
30 |
$3K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$502.84 |