| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16,268 |
8,076 |
$1.47M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,883 |
7,857 |
$1.01M |
| D0210 |
Intraoral - complete series of radiographic images |
15,226 |
14,796 |
$721K |
| D1351 |
Sealant - per tooth |
26,226 |
3,258 |
$530K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20,930 |
20,253 |
$490K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
7,036 |
4,207 |
$469K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,740 |
4,089 |
$426K |
| D1110 |
Prophylaxis - adult |
12,918 |
12,525 |
$421K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,179 |
4,457 |
$407K |
| D0330 |
Panoramic radiographic image |
8,657 |
8,321 |
$325K |
| D0140 |
Limited oral evaluation - problem focused |
8,433 |
8,187 |
$182K |
| D1120 |
Prophylaxis - child |
6,260 |
6,052 |
$164K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,252 |
9,942 |
$162K |
| D0274 |
Bitewings - four radiographic images |
7,439 |
6,676 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
7,267 |
6,995 |
$130K |
| D2330 |
|
1,843 |
687 |
$78K |
| D4355 |
|
867 |
747 |
$47K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
88 |
77 |
$34K |
| D3320 |
|
134 |
113 |
$34K |
| D4341 |
|
347 |
100 |
$31K |
| D2331 |
|
436 |
268 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,422 |
2,338 |
$21K |
| D2335 |
|
167 |
96 |
$12K |
| D5110 |
|
36 |
29 |
$11K |
| D2332 |
|
178 |
95 |
$11K |
| D2394 |
|
89 |
78 |
$7K |
| D1206 |
Topical application of fluoride varnish |
280 |
270 |
$5K |
| D5211 |
|
12 |
12 |
$4K |
| D2931 |
|
20 |
14 |
$3K |
| D3310 |
|
13 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
84 |
76 |
$514.91 |
| D7510 |
|
21 |
20 |
$504.68 |
| D7321 |
|
20 |
17 |
$409.20 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$367.02 |