| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,881 |
1,840 |
$592K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,102 |
2,535 |
$508K |
| D0210 |
Intraoral - complete series of radiographic images |
7,326 |
5,243 |
$353K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,417 |
1,473 |
$293K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,099 |
5,280 |
$216K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,038 |
1,217 |
$154K |
| D1110 |
Prophylaxis - adult |
2,887 |
2,515 |
$127K |
| D4346 |
|
761 |
646 |
$114K |
| D0274 |
Bitewings - four radiographic images |
3,054 |
2,694 |
$95K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
181 |
137 |
$92K |
| D7250 |
|
523 |
209 |
$92K |
| D1351 |
Sealant - per tooth |
3,328 |
435 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
3,214 |
2,848 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
1,976 |
1,673 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
5,700 |
4,902 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,709 |
2,365 |
$51K |
| D1120 |
Prophylaxis - child |
1,736 |
1,524 |
$48K |
| D0330 |
Panoramic radiographic image |
1,692 |
1,438 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,705 |
3,811 |
$42K |
| D2394 |
|
400 |
236 |
$41K |
| D2335 |
|
277 |
132 |
$40K |
| D4341 |
|
595 |
118 |
$39K |
| D2332 |
|
355 |
169 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,207 |
1,068 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
447 |
367 |
$8K |
| D4342 |
|
183 |
42 |
$8K |
| D4910 |
|
68 |
61 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
27 |
$4K |
| D1999 |
|
2,135 |
1,759 |
$580.01 |