| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,266 |
1,238 |
$366K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,223 |
1,147 |
$183K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,801 |
970 |
$122K |
| D1110 |
Prophylaxis - adult |
2,241 |
2,089 |
$94K |
| D2740 |
Crown - porcelain/ceramic |
184 |
111 |
$90K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,010 |
600 |
$85K |
| D9920 |
|
1,124 |
1,070 |
$76K |
| D1120 |
Prophylaxis - child |
2,275 |
2,274 |
$75K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
101 |
87 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,867 |
2,190 |
$66K |
| D9630 |
|
3,387 |
3,279 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
3,088 |
3,013 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
1,383 |
1,182 |
$58K |
| D1206 |
Topical application of fluoride varnish |
2,504 |
2,463 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
2,755 |
1,978 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,765 |
2,112 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
4,784 |
3,554 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,330 |
1,280 |
$33K |
| D1351 |
Sealant - per tooth |
1,003 |
345 |
$31K |
| D2332 |
|
280 |
124 |
$31K |
| D0330 |
Panoramic radiographic image |
781 |
598 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
246 |
157 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,249 |
1,215 |
$25K |
| D8670 |
Periodic orthodontic treatment visit |
74 |
72 |
$23K |
| D2952 |
|
145 |
78 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
339 |
303 |
$11K |
| D4355 |
|
126 |
126 |
$10K |
| D9994 |
|
1,112 |
1,098 |
$9K |
| D3320 |
|
21 |
13 |
$9K |
| D3310 |
|
23 |
12 |
$9K |
| D0272 |
Bitewings - two radiographic images |
235 |
231 |
$5K |
| D2335 |
|
25 |
12 |
$3K |
| D2330 |
|
25 |
15 |
$2K |
| D2394 |
|
13 |
12 |
$2K |
| D3120 |
|
68 |
52 |
$1K |