| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,152 |
1,754 |
$510K |
| D1351 |
Sealant - per tooth |
26,682 |
2,733 |
$489K |
| D2394 |
|
3,957 |
2,039 |
$282K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,763 |
1,834 |
$258K |
| D0210 |
Intraoral - complete series of radiographic images |
5,442 |
5,072 |
$211K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,519 |
6,040 |
$136K |
| D0274 |
Bitewings - four radiographic images |
5,188 |
4,820 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
4,259 |
3,907 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,949 |
5,505 |
$78K |
| D0330 |
Panoramic radiographic image |
2,814 |
2,539 |
$76K |
| D7230 |
|
455 |
210 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,837 |
1,538 |
$73K |
| D0350 |
|
6,348 |
5,821 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
4,152 |
3,869 |
$65K |
| D4355 |
|
1,181 |
1,083 |
$59K |
| D1120 |
Prophylaxis - child |
2,323 |
2,158 |
$55K |
| D4341 |
|
752 |
201 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,108 |
515 |
$53K |
| D1206 |
Topical application of fluoride varnish |
4,152 |
3,872 |
$49K |
| D2330 |
|
1,279 |
579 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
4,642 |
4,298 |
$35K |
| D0250 |
|
3,894 |
3,536 |
$34K |
| D4346 |
|
409 |
387 |
$28K |
| D9110 |
|
1,817 |
1,668 |
$27K |
| D1110 |
Prophylaxis - adult |
681 |
649 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,126 |
3,745 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
483 |
242 |
$22K |
| D2331 |
|
449 |
186 |
$21K |
| D9610 |
|
914 |
796 |
$17K |
| D7511 |
|
227 |
207 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
430 |
177 |
$15K |
| D0170 |
|
825 |
754 |
$14K |
| D7240 |
Removal of impacted tooth - completely bony |
68 |
24 |
$13K |
| D2335 |
|
177 |
113 |
$12K |
| D9910 |
|
1,046 |
500 |
$9K |
| D1510 |
|
108 |
61 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
42 |
27 |
$4K |
| D0160 |
|
84 |
75 |
$4K |
| D4342 |
|
78 |
16 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
25 |
14 |
$1K |
| D7311 |
|
53 |
32 |
$848.40 |
| D0272 |
Bitewings - two radiographic images |
32 |
28 |
$382.60 |
| D0191 |
|
30 |
24 |
$145.11 |