| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15,525 |
4,516 |
$1.28M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,340 |
7,842 |
$820K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
7,067 |
4,992 |
$613K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,846 |
5,311 |
$418K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,748 |
10,488 |
$352K |
| D0330 |
Panoramic radiographic image |
10,683 |
10,451 |
$316K |
| D1110 |
Prophylaxis - adult |
7,111 |
6,978 |
$300K |
| D4341 |
|
8,136 |
2,296 |
$278K |
| D0120 |
Periodic oral evaluation - established patient |
9,447 |
9,303 |
$269K |
| D2335 |
|
2,542 |
1,349 |
$236K |
| D0274 |
Bitewings - four radiographic images |
17,640 |
17,303 |
$220K |
| D2332 |
|
2,760 |
1,567 |
$219K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,338 |
12,140 |
$217K |
| D2394 |
|
1,565 |
1,133 |
$129K |
| D0140 |
Limited oral evaluation - problem focused |
5,250 |
5,080 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
11,970 |
11,664 |
$105K |
| D2331 |
|
1,248 |
855 |
$63K |
| D1999 |
|
4,802 |
3,752 |
$59K |
| D4910 |
|
894 |
874 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,533 |
491 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,085 |
8,708 |
$36K |
| D4342 |
|
1,342 |
471 |
$27K |
| D1120 |
Prophylaxis - child |
1,229 |
1,201 |
$26K |
| D4346 |
|
344 |
341 |
$22K |
| D7250 |
|
394 |
79 |
$22K |
| D1351 |
Sealant - per tooth |
1,279 |
290 |
$22K |
| D2330 |
|
567 |
359 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
467 |
451 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
299 |
266 |
$10K |
| D1206 |
Topical application of fluoride varnish |
453 |
446 |
$5K |
| D0270 |
|
34 |
32 |
$90.72 |