| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
2,583 |
1,971 |
$1.44M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
803 |
702 |
$397K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,478 |
2,074 |
$336K |
| D1351 |
Sealant - per tooth |
14,638 |
1,964 |
$322K |
| D1110 |
Prophylaxis - adult |
6,833 |
6,776 |
$309K |
| D0210 |
Intraoral - complete series of radiographic images |
4,162 |
4,151 |
$211K |
| D0140 |
Limited oral evaluation - problem focused |
4,876 |
4,796 |
$199K |
| D2954 |
|
2,033 |
1,598 |
$196K |
| D1120 |
Prophylaxis - child |
3,708 |
3,666 |
$171K |
| D1206 |
Topical application of fluoride varnish |
4,425 |
4,374 |
$148K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,425 |
6,371 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,723 |
5,662 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
4,214 |
4,173 |
$106K |
| D0330 |
Panoramic radiographic image |
5,979 |
5,888 |
$88K |
| D3320 |
|
229 |
190 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,399 |
994 |
$70K |
| D0274 |
Bitewings - four radiographic images |
5,129 |
5,062 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
812 |
345 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
826 |
571 |
$32K |
| D4341 |
|
406 |
159 |
$27K |
| D7240 |
Removal of impacted tooth - completely bony |
69 |
25 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
4,412 |
4,325 |
$18K |
| D4910 |
|
206 |
200 |
$17K |
| D0601 |
|
1,132 |
1,116 |
$10K |
| D0272 |
Bitewings - two radiographic images |
1,334 |
1,312 |
$6K |
| D0603 |
|
678 |
666 |
$6K |
| D0602 |
|
559 |
552 |
$5K |
| D7230 |
|
17 |
13 |
$4K |
| D4355 |
|
27 |
27 |
$3K |
| D0170 |
|
74 |
71 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,815 |
1,021 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
28 |
$2K |