| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
1,153 |
436 |
$222K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,303 |
1,641 |
$182K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,079 |
1,091 |
$169K |
| D7230 |
|
699 |
358 |
$109K |
| D0330 |
Panoramic radiographic image |
2,382 |
2,316 |
$107K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,318 |
796 |
$87K |
| D1110 |
Prophylaxis - adult |
2,152 |
2,080 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,395 |
2,337 |
$63K |
| D7220 |
|
555 |
318 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,417 |
2,345 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,612 |
2,531 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
743 |
444 |
$39K |
| D4341 |
|
431 |
127 |
$38K |
| D2394 |
|
424 |
314 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,407 |
1,350 |
$22K |
| D1120 |
Prophylaxis - child |
876 |
835 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
806 |
774 |
$17K |
| D2335 |
|
206 |
102 |
$17K |
| D1351 |
Sealant - per tooth |
563 |
127 |
$12K |
| D3320 |
|
45 |
39 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
25 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
2,020 |
1,896 |
$10K |
| D0180 |
|
300 |
288 |
$8K |
| D2332 |
|
76 |
52 |
$5K |
| D3310 |
|
18 |
13 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
861 |
690 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
14 |
$3K |
| D2331 |
|
53 |
41 |
$3K |
| D0272 |
Bitewings - two radiographic images |
214 |
204 |
$2K |
| D2950 |
|
13 |
12 |
$926.09 |
| D1206 |
Topical application of fluoride varnish |
17 |
17 |
$285.75 |