| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,193 |
1,488 |
$867K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,752 |
2,544 |
$435K |
| D2720 |
|
307 |
181 |
$331K |
| D0330 |
Panoramic radiographic image |
3,497 |
3,417 |
$275K |
| D0120 |
Periodic oral evaluation - established patient |
6,844 |
6,752 |
$268K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,579 |
1,953 |
$240K |
| D1110 |
Prophylaxis - adult |
3,842 |
3,778 |
$232K |
| D0274 |
Bitewings - four radiographic images |
4,997 |
4,906 |
$231K |
| D1206 |
Topical application of fluoride varnish |
6,938 |
6,841 |
$214K |
| D1120 |
Prophylaxis - child |
4,032 |
3,981 |
$168K |
| D0140 |
Limited oral evaluation - problem focused |
4,002 |
3,831 |
$166K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,176 |
829 |
$136K |
| D5110 |
|
95 |
89 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,976 |
1,918 |
$87K |
| D9239 |
|
400 |
399 |
$86K |
| D9243 |
|
400 |
399 |
$86K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,336 |
3,475 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
4,758 |
4,547 |
$78K |
| D1330 |
|
2,443 |
2,410 |
$75K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
899 |
524 |
$74K |
| D7250 |
|
272 |
83 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,580 |
2,466 |
$58K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
65 |
57 |
$49K |
| D1310 |
|
2,514 |
2,487 |
$48K |
| D2331 |
|
383 |
272 |
$45K |
| D2160 |
|
447 |
295 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
491 |
215 |
$41K |
| D2335 |
|
281 |
169 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,024 |
1,004 |
$37K |
| D7240 |
Removal of impacted tooth - completely bony |
101 |
40 |
$34K |
| D7111 |
|
272 |
172 |
$30K |
| D2332 |
|
148 |
100 |
$19K |
| D2950 |
|
82 |
71 |
$16K |
| D4910 |
|
139 |
137 |
$12K |
| D2954 |
|
56 |
43 |
$12K |
| D2330 |
|
92 |
67 |
$9K |
| D2140 |
|
74 |
49 |
$6K |
| D2161 |
|
38 |
26 |
$5K |
| D2394 |
|
27 |
24 |
$4K |
| D1351 |
Sealant - per tooth |
29 |
14 |
$800.96 |