| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,820 |
2,782 |
$1.21M |
| D2740 |
Crown - porcelain/ceramic |
1,603 |
995 |
$1.12M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,673 |
3,070 |
$542K |
| D1351 |
Sealant - per tooth |
15,512 |
2,203 |
$480K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,249 |
1,668 |
$311K |
| D0210 |
Intraoral - complete series of radiographic images |
4,371 |
4,336 |
$288K |
| D1110 |
Prophylaxis - adult |
5,515 |
5,502 |
$279K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,394 |
6,391 |
$262K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,469 |
1,706 |
$207K |
| D0140 |
Limited oral evaluation - problem focused |
4,861 |
4,769 |
$202K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,221 |
822 |
$179K |
| D2950 |
|
996 |
747 |
$175K |
| D1120 |
Prophylaxis - child |
3,935 |
3,934 |
$161K |
| D0120 |
Periodic oral evaluation - established patient |
5,782 |
5,773 |
$157K |
| D0220 |
Intraoral - periapical first radiographic image |
9,258 |
9,085 |
$147K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
225 |
215 |
$137K |
| D3320 |
|
247 |
231 |
$124K |
| D5110 |
|
140 |
139 |
$123K |
| D4341 |
|
827 |
295 |
$122K |
| D1206 |
Topical application of fluoride varnish |
4,636 |
4,633 |
$116K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,456 |
6,658 |
$114K |
| D0274 |
Bitewings - four radiographic images |
3,547 |
3,537 |
$111K |
| D2332 |
|
676 |
391 |
$81K |
| D0330 |
Panoramic radiographic image |
1,026 |
1,026 |
$60K |
| D3310 |
|
118 |
76 |
$48K |
| D4355 |
|
435 |
434 |
$47K |
| D5120 |
|
41 |
40 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,502 |
1,501 |
$35K |
| D9243 |
|
391 |
80 |
$26K |
| D4910 |
|
194 |
194 |
$18K |
| D2394 |
|
102 |
82 |
$17K |
| D2331 |
|
154 |
107 |
$16K |
| D2330 |
|
214 |
150 |
$16K |
| D0191 |
|
2,227 |
2,225 |
$11K |
| D2335 |
|
47 |
25 |
$6K |
| D9239 |
|
80 |
80 |
$6K |
| D7220 |
|
21 |
12 |
$4K |
| D7230 |
|
18 |
12 |
$4K |
| D9110 |
|
20 |
19 |
$2K |
| D0603 |
|
22 |
22 |
$15.00 |
| D0602 |
|
30 |
30 |
$15.00 |
| D0601 |
|
18 |
17 |
$0.00 |
| D1999 |
|
1,950 |
1,683 |
$0.00 |
| D0350 |
|
138 |
138 |
$0.00 |