| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2720 |
|
777 |
477 |
$669K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,795 |
1,197 |
$498K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,474 |
1,590 |
$304K |
| D0330 |
Panoramic radiographic image |
3,698 |
3,664 |
$257K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,788 |
637 |
$171K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,777 |
3,742 |
$156K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
247 |
223 |
$144K |
| D0274 |
Bitewings - four radiographic images |
3,806 |
3,784 |
$141K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,996 |
1,157 |
$138K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,513 |
679 |
$137K |
| D8670 |
Periodic orthodontic treatment visit |
653 |
649 |
$136K |
| D1110 |
Prophylaxis - adult |
2,179 |
2,167 |
$124K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,021 |
641 |
$110K |
| D2331 |
|
1,005 |
648 |
$105K |
| D5110 |
|
96 |
96 |
$95K |
| D0140 |
Limited oral evaluation - problem focused |
2,497 |
2,442 |
$95K |
| D2950 |
|
592 |
449 |
$94K |
| D4341 |
|
455 |
209 |
$83K |
| D2160 |
|
714 |
407 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
1,834 |
1,830 |
$59K |
| D2332 |
|
448 |
260 |
$57K |
| D5120 |
|
53 |
52 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,293 |
3,158 |
$50K |
| D1120 |
Prophylaxis - child |
1,252 |
1,250 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,458 |
2,055 |
$49K |
| D6750 |
|
44 |
12 |
$39K |
| D4342 |
|
303 |
150 |
$38K |
| D5214 |
|
29 |
29 |
$33K |
| D2140 |
|
457 |
279 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,094 |
1,092 |
$31K |
| D1206 |
Topical application of fluoride varnish |
916 |
914 |
$27K |
| D2740 |
Crown - porcelain/ceramic |
51 |
34 |
$26K |
| D3320 |
|
53 |
50 |
$25K |
| D2330 |
|
302 |
208 |
$24K |
| D4910 |
|
297 |
293 |
$20K |
| D1330 |
|
934 |
932 |
$19K |
| D2335 |
|
140 |
90 |
$19K |
| D0272 |
Bitewings - two radiographic images |
531 |
526 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
505 |
453 |
$10K |
| D0270 |
|
843 |
831 |
$9K |
| D2161 |
|
42 |
25 |
$6K |
| D2394 |
|
37 |
28 |
$5K |
| D1351 |
Sealant - per tooth |
99 |
26 |
$3K |
| D0340 |
|
13 |
13 |
$1K |
| D0273 |
|
15 |
15 |
$591.69 |
| D0460 |
|
15 |
14 |
$22.17 |