| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,428 |
346 |
$313K |
| D0330 |
Panoramic radiographic image |
2,476 |
2,034 |
$192K |
| D0140 |
Limited oral evaluation - problem focused |
3,276 |
2,782 |
$178K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,684 |
2,198 |
$139K |
| D0274 |
Bitewings - four radiographic images |
2,922 |
2,410 |
$137K |
| D1110 |
Prophylaxis - adult |
1,978 |
1,671 |
$137K |
| D2740 |
Crown - porcelain/ceramic |
233 |
174 |
$133K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
970 |
400 |
$117K |
| D0220 |
Intraoral - periapical first radiographic image |
2,926 |
2,491 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
244 |
126 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
271 |
120 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
688 |
568 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
954 |
816 |
$23K |
| D2950 |
|
114 |
91 |
$20K |
| D2954 |
|
131 |
71 |
$19K |
| D9211 |
|
280 |
91 |
$17K |
| D1351 |
Sealant - per tooth |
294 |
32 |
$13K |
| D1120 |
Prophylaxis - child |
141 |
130 |
$7K |
| D1206 |
Topical application of fluoride varnish |
272 |
262 |
$7K |
| D9243 |
|
14 |
13 |
$5K |
| D9610 |
|
64 |
57 |
$5K |
| D2335 |
|
17 |
12 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
118 |
94 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
41 |
$3K |
| D2330 |
|
35 |
14 |
$3K |
| D2331 |
|
31 |
15 |
$3K |
| D4355 |
|
15 |
14 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
41 |
29 |
$2K |
| D9239 |
|
14 |
13 |
$1K |
| D4910 |
|
12 |
12 |
$1K |
| D2993 |
|
20 |
15 |
$0.00 |