| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,155 |
1,043 |
$384K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,022 |
2,000 |
$299K |
| D1110 |
Prophylaxis - adult |
5,026 |
4,566 |
$240K |
| D1351 |
Sealant - per tooth |
8,150 |
1,050 |
$201K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,440 |
4,928 |
$193K |
| D0210 |
Intraoral - complete series of radiographic images |
3,211 |
2,828 |
$192K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,391 |
1,591 |
$191K |
| D0274 |
Bitewings - four radiographic images |
4,631 |
4,195 |
$141K |
| D0140 |
Limited oral evaluation - problem focused |
2,849 |
2,462 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
4,185 |
3,804 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,038 |
639 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,483 |
5,892 |
$87K |
| D7250 |
|
339 |
127 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
6,329 |
5,673 |
$74K |
| D1120 |
Prophylaxis - child |
2,422 |
2,193 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,260 |
3,808 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
757 |
326 |
$62K |
| D2335 |
|
274 |
157 |
$45K |
| D2330 |
|
441 |
216 |
$36K |
| D0330 |
Panoramic radiographic image |
742 |
659 |
$30K |
| D2332 |
|
257 |
139 |
$30K |
| D2331 |
|
213 |
123 |
$20K |
| D0272 |
Bitewings - two radiographic images |
219 |
202 |
$5K |
| D0270 |
|
247 |
215 |
$4K |
| D4346 |
|
30 |
28 |
$4K |
| D1206 |
Topical application of fluoride varnish |
115 |
99 |
$2K |
| D4355 |
|
12 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$355.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$309.50 |