| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
9,977 |
3,461 |
$989K |
| D1351 |
Sealant - per tooth |
38,000 |
4,525 |
$776K |
| D0210 |
Intraoral - complete series of radiographic images |
11,692 |
11,582 |
$601K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,236 |
4,266 |
$600K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,602 |
2,780 |
$428K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,728 |
2,829 |
$331K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,968 |
12,851 |
$308K |
| D1110 |
Prophylaxis - adult |
5,519 |
5,455 |
$182K |
| D7230 |
|
897 |
563 |
$170K |
| D4355 |
|
2,024 |
2,007 |
$167K |
| D0330 |
Panoramic radiographic image |
3,314 |
3,277 |
$165K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,716 |
7,632 |
$123K |
| D1120 |
Prophylaxis - child |
4,501 |
4,460 |
$121K |
| D2332 |
|
1,423 |
723 |
$100K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,180 |
879 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
4,431 |
4,379 |
$82K |
| D4341 |
|
877 |
272 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
2,494 |
2,419 |
$58K |
| D4346 |
|
400 |
399 |
$38K |
| D2394 |
|
379 |
269 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,524 |
1,504 |
$33K |
| D7240 |
Removal of impacted tooth - completely bony |
111 |
57 |
$21K |
| D7311 |
|
301 |
208 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,967 |
1,941 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,805 |
1,638 |
$13K |
| D3320 |
|
52 |
41 |
$12K |
| D5110 |
|
14 |
13 |
$7K |
| D2335 |
|
76 |
41 |
$5K |
| D2330 |
|
85 |
49 |
$4K |
| D7310 |
|
44 |
17 |
$4K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
19 |
14 |
$4K |
| D7250 |
|
36 |
15 |
$4K |
| D2331 |
|
22 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
71 |
70 |
$1K |
| D0272 |
Bitewings - two radiographic images |
60 |
59 |
$1K |
| D4342 |
|
23 |
14 |
$872.82 |