| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
32,184 |
4,867 |
$2.62M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,725 |
2,462 |
$1.00M |
| D0210 |
Intraoral - complete series of radiographic images |
5,166 |
4,441 |
$291K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,011 |
1,551 |
$283K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,455 |
2,261 |
$261K |
| D7240 |
Removal of impacted tooth - completely bony |
890 |
256 |
$253K |
| D1110 |
Prophylaxis - adult |
5,524 |
4,965 |
$230K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,603 |
1,482 |
$199K |
| D0140 |
Limited oral evaluation - problem focused |
5,783 |
5,116 |
$193K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,319 |
4,768 |
$173K |
| D0120 |
Periodic oral evaluation - established patient |
7,852 |
7,069 |
$157K |
| D1351 |
Sealant - per tooth |
6,764 |
1,300 |
$134K |
| D1120 |
Prophylaxis - child |
4,712 |
4,246 |
$126K |
| D1206 |
Topical application of fluoride varnish |
7,572 |
6,923 |
$120K |
| D2335 |
|
698 |
344 |
$101K |
| D0274 |
Bitewings - four radiographic images |
3,031 |
2,735 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
8,606 |
7,540 |
$89K |
| D7250 |
|
365 |
133 |
$78K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,421 |
2,846 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,254 |
3,571 |
$65K |
| D0330 |
Panoramic radiographic image |
1,361 |
1,218 |
$55K |
| D4346 |
|
346 |
313 |
$55K |
| D2332 |
|
525 |
313 |
$53K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
263 |
178 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
918 |
508 |
$35K |
| D2949 |
|
172 |
97 |
$29K |
| D2394 |
|
255 |
173 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,587 |
1,343 |
$20K |
| D3240 |
|
173 |
122 |
$18K |
| D0272 |
Bitewings - two radiographic images |
931 |
797 |
$16K |
| D9243 |
|
306 |
71 |
$16K |
| D9239 |
|
99 |
68 |
$5K |
| D1510 |
|
25 |
16 |
$4K |
| D2331 |
|
39 |
26 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
72 |
69 |
$2K |
| D1320 |
|
35 |
33 |
$738.90 |
| D2740 |
Crown - porcelain/ceramic |
15 |
13 |
$500.00 |
| D0383 |
|
140 |
131 |
$424.47 |
| D0270 |
|
30 |
28 |
$96.83 |
| D4999 |
|
34 |
25 |
$0.00 |
| D0350 |
|
614 |
552 |
$0.00 |
| D0431 |
|
566 |
521 |
$0.00 |