| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
9,069 |
4,255 |
$1.42M |
| D1110 |
Prophylaxis - adult |
15,015 |
14,023 |
$699K |
| D1351 |
Sealant - per tooth |
25,129 |
3,958 |
$588K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,774 |
5,134 |
$583K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,631 |
2,936 |
$572K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,708 |
12,712 |
$477K |
| D0140 |
Limited oral evaluation - problem focused |
11,066 |
10,011 |
$414K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46,892 |
19,754 |
$380K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,710 |
3,483 |
$313K |
| D0120 |
Periodic oral evaluation - established patient |
14,442 |
13,562 |
$310K |
| D0274 |
Bitewings - four radiographic images |
10,789 |
9,857 |
$284K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,349 |
2,373 |
$276K |
| D0220 |
Intraoral - periapical first radiographic image |
22,897 |
20,948 |
$262K |
| D1120 |
Prophylaxis - child |
8,215 |
7,681 |
$243K |
| D2335 |
|
1,688 |
979 |
$242K |
| D0210 |
Intraoral - complete series of radiographic images |
7,569 |
6,159 |
$239K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,713 |
10,920 |
$218K |
| D4341 |
|
1,758 |
463 |
$189K |
| D2332 |
|
1,603 |
1,024 |
$171K |
| D0330 |
Panoramic radiographic image |
2,807 |
2,583 |
$145K |
| D7250 |
|
456 |
200 |
$99K |
| D7230 |
|
278 |
170 |
$73K |
| D0272 |
Bitewings - two radiographic images |
3,141 |
2,912 |
$67K |
| D2330 |
|
889 |
511 |
$64K |
| D0270 |
|
3,342 |
3,123 |
$59K |
| D5110 |
|
134 |
120 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
475 |
244 |
$41K |
| D2331 |
|
384 |
247 |
$37K |
| D2394 |
|
375 |
289 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,206 |
1,129 |
$27K |
| D7311 |
|
126 |
82 |
$19K |
| D4346 |
|
94 |
87 |
$16K |
| D2160 |
|
130 |
77 |
$14K |
| D7310 |
|
88 |
43 |
$13K |
| D4910 |
|
105 |
95 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
67 |
57 |
$10K |
| D4342 |
|
79 |
36 |
$10K |
| D5120 |
|
30 |
28 |
$8K |
| D2140 |
|
99 |
55 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
426 |
364 |
$4K |
| D2931 |
|
201 |
151 |
$4K |
| D0273 |
|
96 |
91 |
$2K |
| D4355 |
|
19 |
16 |
$2K |