| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,360 |
1,107 |
$326K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,503 |
1,449 |
$259K |
| D0330 |
Panoramic radiographic image |
4,047 |
3,873 |
$206K |
| D0140 |
Limited oral evaluation - problem focused |
8,214 |
7,571 |
$205K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,580 |
1,227 |
$171K |
| D9243 |
|
3,994 |
999 |
$164K |
| D0210 |
Intraoral - complete series of radiographic images |
2,496 |
2,267 |
$151K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,358 |
3,217 |
$109K |
| D9239 |
|
1,362 |
1,285 |
$104K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,234 |
297 |
$91K |
| D2331 |
|
601 |
279 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
720 |
435 |
$55K |
| D1110 |
Prophylaxis - adult |
1,172 |
1,124 |
$50K |
| D9612 |
|
744 |
721 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,730 |
1,874 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,451 |
1,378 |
$36K |
| D2330 |
|
400 |
183 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,247 |
1,178 |
$29K |
| D2332 |
|
274 |
165 |
$29K |
| D7240 |
Removal of impacted tooth - completely bony |
136 |
52 |
$26K |
| D7230 |
|
160 |
74 |
$25K |
| D7310 |
|
183 |
66 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,743 |
2,553 |
$17K |
| D1206 |
Topical application of fluoride varnish |
589 |
576 |
$12K |
| D1120 |
Prophylaxis - child |
402 |
392 |
$10K |
| D0250 |
|
650 |
564 |
$9K |
| D2335 |
|
42 |
26 |
$8K |
| D7250 |
|
36 |
13 |
$5K |
| D1351 |
Sealant - per tooth |
68 |
15 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
51 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
123 |
121 |
$2K |
| D9610 |
|
76 |
51 |
$2K |
| D9222 |
|
13 |
13 |
$2K |
| D0350 |
|
72 |
70 |
$912.98 |
| D2140 |
|
20 |
14 |
$840.00 |
| D0270 |
|
58 |
57 |
$274.75 |