| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,232 |
2,568 |
$1.44M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,112 |
4,222 |
$622K |
| D1351 |
Sealant - per tooth |
18,629 |
2,627 |
$488K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,495 |
1,648 |
$476K |
| D1110 |
Prophylaxis - adult |
7,020 |
6,572 |
$356K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,525 |
3,051 |
$331K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,071 |
7,364 |
$301K |
| D0120 |
Periodic oral evaluation - established patient |
11,610 |
10,989 |
$274K |
| D0330 |
Panoramic radiographic image |
5,853 |
5,289 |
$265K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,628 |
1,709 |
$254K |
| D0274 |
Bitewings - four radiographic images |
6,885 |
6,333 |
$211K |
| D1120 |
Prophylaxis - child |
6,338 |
5,956 |
$208K |
| D0210 |
Intraoral - complete series of radiographic images |
9,239 |
4,643 |
$178K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,886 |
7,334 |
$162K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
270 |
232 |
$161K |
| D2931 |
|
653 |
554 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
11,960 |
10,814 |
$126K |
| D0140 |
Limited oral evaluation - problem focused |
2,841 |
2,677 |
$106K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,860 |
9,072 |
$103K |
| D2332 |
|
828 |
488 |
$97K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,343 |
2,947 |
$90K |
| D2330 |
|
1,002 |
594 |
$86K |
| D1206 |
Topical application of fluoride varnish |
3,014 |
2,832 |
$69K |
| D2331 |
|
649 |
438 |
$66K |
| D4346 |
|
522 |
455 |
$66K |
| D2335 |
|
456 |
271 |
$64K |
| D0272 |
Bitewings - two radiographic images |
2,601 |
2,407 |
$51K |
| D5110 |
|
55 |
53 |
$28K |
| D4910 |
|
241 |
209 |
$26K |
| D4341 |
|
158 |
39 |
$22K |
| D5120 |
|
29 |
26 |
$14K |
| D2949 |
|
94 |
74 |
$12K |
| D7310 |
|
40 |
14 |
$8K |
| D4342 |
|
87 |
26 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
135 |
116 |
$3K |
| D0270 |
|
46 |
42 |
$783.64 |
| D1330 |
|
275 |
252 |
$0.00 |