| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
11,829 |
3,214 |
$2.11M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
9,793 |
2,044 |
$1.90M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,913 |
4,077 |
$1.44M |
| D2740 |
Crown - porcelain/ceramic |
2,778 |
1,077 |
$1.30M |
| D0330 |
Panoramic radiographic image |
15,363 |
10,931 |
$1.02M |
| D1351 |
Sealant - per tooth |
22,181 |
2,146 |
$983K |
| D2950 |
|
5,412 |
1,842 |
$749K |
| D0140 |
Limited oral evaluation - problem focused |
10,534 |
8,914 |
$585K |
| D1110 |
Prophylaxis - adult |
9,961 |
6,922 |
$576K |
| D0274 |
Bitewings - four radiographic images |
14,448 |
9,618 |
$547K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,091 |
8,143 |
$511K |
| D2335 |
|
2,660 |
514 |
$500K |
| D1120 |
Prophylaxis - child |
6,894 |
6,605 |
$411K |
| D0120 |
Periodic oral evaluation - established patient |
10,085 |
8,497 |
$385K |
| D9243 |
|
732 |
659 |
$290K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,555 |
9,049 |
$255K |
| D2394 |
|
1,094 |
264 |
$248K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,731 |
441 |
$202K |
| D0272 |
Bitewings - two radiographic images |
5,014 |
4,780 |
$188K |
| D0220 |
Intraoral - periapical first radiographic image |
6,901 |
5,711 |
$136K |
| D9248 |
|
621 |
518 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,004 |
347 |
$95K |
| D9610 |
|
1,270 |
975 |
$85K |
| D9239 |
|
715 |
658 |
$77K |
| D5110 |
|
105 |
53 |
$53K |
| D2332 |
|
367 |
99 |
$47K |
| D5214 |
|
93 |
47 |
$43K |
| D3240 |
|
150 |
31 |
$42K |
| D5213 |
|
74 |
37 |
$34K |
| D4341 |
|
138 |
63 |
$23K |
| D7240 |
Removal of impacted tooth - completely bony |
42 |
12 |
$16K |
| D5120 |
|
34 |
15 |
$16K |
| D9420 |
|
231 |
138 |
$12K |
| D2330 |
|
37 |
12 |
$4K |
| D2331 |
|
39 |
14 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
14 |
$456.08 |