| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,470 |
2,772 |
$956K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,812 |
3,331 |
$684K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,121 |
2,128 |
$429K |
| D0210 |
Intraoral - complete series of radiographic images |
9,048 |
6,504 |
$416K |
| D4346 |
|
1,570 |
1,362 |
$259K |
| D7250 |
|
1,299 |
602 |
$254K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,368 |
6,495 |
$250K |
| D1351 |
Sealant - per tooth |
8,554 |
1,265 |
$214K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
366 |
281 |
$201K |
| D1110 |
Prophylaxis - adult |
4,224 |
3,776 |
$182K |
| D0274 |
Bitewings - four radiographic images |
5,380 |
4,808 |
$164K |
| D7240 |
Removal of impacted tooth - completely bony |
485 |
186 |
$156K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,546 |
1,146 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
5,561 |
4,955 |
$121K |
| D7220 |
|
469 |
227 |
$94K |
| D2394 |
|
782 |
431 |
$78K |
| D2332 |
|
723 |
341 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
2,482 |
2,199 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
8,217 |
7,196 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,729 |
3,353 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,237 |
6,028 |
$65K |
| D3320 |
|
131 |
95 |
$64K |
| D0330 |
Panoramic radiographic image |
2,109 |
1,876 |
$60K |
| D2335 |
|
400 |
194 |
$57K |
| D1120 |
Prophylaxis - child |
1,915 |
1,724 |
$56K |
| D4341 |
|
589 |
126 |
$47K |
| D4910 |
|
278 |
250 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,469 |
1,305 |
$28K |
| D4212 |
|
75 |
27 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
66 |
$13K |
| D7230 |
|
40 |
27 |
$11K |
| D4342 |
|
126 |
28 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
260 |
197 |
$5K |
| D2330 |
|
41 |
12 |
$2K |
| D1999 |
|
1,524 |
1,263 |
$910.48 |
| D7510 |
|
18 |
12 |
$542.50 |