| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,557 |
1,896 |
$1.15M |
| D2740 |
Crown - porcelain/ceramic |
478 |
364 |
$298K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,069 |
1,196 |
$239K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,386 |
464 |
$198K |
| D0210 |
Intraoral - complete series of radiographic images |
2,941 |
2,930 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,304 |
3,290 |
$125K |
| D1110 |
Prophylaxis - adult |
2,184 |
2,172 |
$106K |
| D5130 |
|
109 |
109 |
$104K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
898 |
581 |
$80K |
| D4341 |
|
503 |
185 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,146 |
1,116 |
$54K |
| D5140 |
|
48 |
48 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
309 |
202 |
$45K |
| D2950 |
|
246 |
202 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,322 |
1,317 |
$33K |
| D0274 |
Bitewings - four radiographic images |
810 |
809 |
$23K |
| D5110 |
|
24 |
24 |
$20K |
| D4910 |
|
201 |
201 |
$14K |
| D1206 |
Topical application of fluoride varnish |
2,282 |
2,265 |
$13K |
| D0330 |
Panoramic radiographic image |
234 |
234 |
$11K |
| D4346 |
|
165 |
164 |
$7K |
| D1120 |
Prophylaxis - child |
96 |
96 |
$4K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
34 |
15 |
$3K |
| D9222 |
|
16 |
15 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
55 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
13 |
$240.00 |
| D4921 |
|
3,807 |
1,094 |
$0.00 |
| D4381 |
|
433 |
65 |
$0.00 |
| D0431 |
|
105 |
105 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
17 |
$0.00 |
| D9610 |
|
15 |
15 |
$0.00 |
| D9630 |
|
1,629 |
1,106 |
$0.00 |
| D3120 |
|
29 |
24 |
$0.00 |