| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,789 |
3,620 |
$835K |
| D0140 |
Limited oral evaluation - problem focused |
16,662 |
14,445 |
$534K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,981 |
3,470 |
$493K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
852 |
683 |
$419K |
| D0330 |
Panoramic radiographic image |
5,327 |
4,594 |
$256K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,884 |
2,339 |
$252K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,328 |
1,546 |
$189K |
| D1110 |
Prophylaxis - adult |
3,961 |
3,422 |
$160K |
| D2335 |
|
968 |
568 |
$131K |
| D0220 |
Intraoral - periapical first radiographic image |
11,511 |
9,750 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,462 |
3,019 |
$105K |
| D0274 |
Bitewings - four radiographic images |
3,431 |
2,934 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
3,006 |
2,435 |
$91K |
| D3320 |
|
192 |
143 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,477 |
978 |
$70K |
| D2394 |
|
592 |
470 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,385 |
2,057 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,595 |
1,737 |
$22K |
| D2332 |
|
131 |
80 |
$13K |
| D2331 |
|
83 |
53 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
462 |
379 |
$6K |
| D7250 |
|
26 |
12 |
$3K |
| D2330 |
|
47 |
27 |
$1K |
| D0270 |
|
63 |
55 |
$1K |
| D1120 |
Prophylaxis - child |
28 |
25 |
$343.62 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$231.11 |