| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
11,300 |
4,581 |
$1.98M |
| D7250 |
|
3,278 |
1,247 |
$696K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,627 |
1,815 |
$576K |
| D0210 |
Intraoral - complete series of radiographic images |
7,568 |
6,191 |
$495K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,962 |
6,733 |
$313K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,745 |
1,736 |
$280K |
| D2335 |
|
1,588 |
741 |
$252K |
| D0140 |
Limited oral evaluation - problem focused |
6,118 |
5,113 |
$236K |
| D2949 |
|
1,062 |
728 |
$193K |
| D0330 |
Panoramic radiographic image |
3,635 |
3,060 |
$187K |
| D5110 |
|
382 |
332 |
$186K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,013 |
1,108 |
$183K |
| D2332 |
|
1,281 |
688 |
$149K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,002 |
1,009 |
$116K |
| D5120 |
|
184 |
158 |
$92K |
| D1110 |
Prophylaxis - adult |
1,598 |
1,386 |
$78K |
| D4346 |
|
360 |
299 |
$70K |
| D2331 |
|
653 |
363 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
3,776 |
3,194 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,132 |
971 |
$41K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
56 |
41 |
$28K |
| D7310 |
|
155 |
46 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,322 |
1,630 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
920 |
825 |
$22K |
| D3320 |
|
43 |
37 |
$18K |
| D3310 |
|
53 |
25 |
$16K |
| D1206 |
Topical application of fluoride varnish |
551 |
514 |
$10K |
| D2394 |
|
78 |
50 |
$10K |
| D7311 |
|
70 |
32 |
$10K |
| D4341 |
|
54 |
14 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
651 |
523 |
$7K |
| D2330 |
|
56 |
31 |
$5K |
| D1999 |
|
167 |
95 |
$4K |
| D1120 |
Prophylaxis - child |
140 |
135 |
$3K |
| D1351 |
Sealant - per tooth |
75 |
13 |
$2K |
| D7510 |
|
19 |
12 |
$341.25 |
| D0460 |
|
13 |
13 |
$0.00 |
| D1330 |
|
82 |
79 |
$0.00 |