| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19,178 |
6,484 |
$2.23M |
| D2740 |
Crown - porcelain/ceramic |
3,738 |
2,870 |
$1.75M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
3,012 |
2,868 |
$1.36M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19,769 |
19,723 |
$1.25M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,985 |
9,230 |
$1.06M |
| D0210 |
Intraoral - complete series of radiographic images |
19,103 |
19,040 |
$893K |
| D0120 |
Periodic oral evaluation - established patient |
12,773 |
12,727 |
$746K |
| D3320 |
|
1,537 |
1,368 |
$544K |
| D4341 |
|
7,325 |
2,006 |
$496K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,833 |
3,802 |
$367K |
| D1120 |
Prophylaxis - child |
9,056 |
9,035 |
$340K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,869 |
2,856 |
$305K |
| D4910 |
|
3,639 |
3,620 |
$274K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,640 |
1,380 |
$264K |
| D5130 |
|
441 |
436 |
$258K |
| D0274 |
Bitewings - four radiographic images |
10,980 |
10,955 |
$223K |
| D2330 |
|
2,860 |
1,521 |
$217K |
| D3310 |
|
739 |
492 |
$215K |
| D9430 |
|
5,958 |
5,852 |
$185K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43,789 |
16,972 |
$175K |
| D1110 |
Prophylaxis - adult |
2,098 |
2,094 |
$172K |
| D1351 |
Sealant - per tooth |
4,506 |
982 |
$163K |
| D1206 |
Topical application of fluoride varnish |
7,683 |
7,652 |
$112K |
| D2952 |
|
962 |
838 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,137 |
8,128 |
$90K |
| D4342 |
|
1,091 |
342 |
$44K |
| D5140 |
|
69 |
69 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
3,403 |
3,380 |
$40K |
| D7230 |
|
132 |
98 |
$24K |
| D7220 |
|
92 |
71 |
$11K |
| D0270 |
|
2,031 |
2,019 |
$10K |
| D7310 |
|
1,620 |
813 |
$10K |
| D2394 |
|
103 |
91 |
$8K |
| D5410 |
|
615 |
515 |
$7K |
| D7240 |
Removal of impacted tooth - completely bony |
24 |
13 |
$6K |
| D2335 |
|
35 |
25 |
$4K |
| D5850 |
|
57 |
56 |
$3K |
| D2332 |
|
35 |
26 |
$2K |
| D5750 |
|
12 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
139 |
139 |
$2K |
| D5411 |
|
133 |
104 |
$1K |
| D5851 |
|
13 |
13 |
$910.00 |