| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14,831 |
6,375 |
$1.31M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,767 |
6,494 |
$1.14M |
| D0210 |
Intraoral - complete series of radiographic images |
13,465 |
13,360 |
$674K |
| D5110 |
|
1,225 |
1,221 |
$630K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,092 |
4,214 |
$578K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,971 |
3,440 |
$557K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,185 |
3,894 |
$537K |
| D0140 |
Limited oral evaluation - problem focused |
18,515 |
18,159 |
$529K |
| D2740 |
Crown - porcelain/ceramic |
896 |
701 |
$507K |
| D4355 |
|
7,182 |
7,150 |
$497K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,719 |
14,685 |
$480K |
| D1110 |
Prophylaxis - adult |
10,575 |
10,547 |
$438K |
| D5120 |
|
653 |
653 |
$337K |
| D1120 |
Prophylaxis - child |
7,729 |
7,718 |
$309K |
| D0120 |
Periodic oral evaluation - established patient |
11,447 |
11,430 |
$274K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33,165 |
14,407 |
$254K |
| D0220 |
Intraoral - periapical first radiographic image |
19,892 |
19,647 |
$240K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,923 |
7,912 |
$191K |
| D4341 |
|
1,439 |
656 |
$174K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
340 |
333 |
$172K |
| D2950 |
|
1,057 |
905 |
$153K |
| D0330 |
Panoramic radiographic image |
3,032 |
3,029 |
$142K |
| D0274 |
Bitewings - four radiographic images |
4,868 |
4,861 |
$133K |
| D1351 |
Sealant - per tooth |
4,233 |
695 |
$126K |
| D9243 |
|
1,154 |
387 |
$121K |
| D3320 |
|
281 |
264 |
$112K |
| D5214 |
|
209 |
209 |
$99K |
| D2335 |
|
948 |
609 |
$94K |
| D0272 |
Bitewings - two radiographic images |
4,448 |
4,433 |
$87K |
| D2332 |
|
748 |
465 |
$58K |
| D2394 |
|
472 |
394 |
$56K |
| D7230 |
|
259 |
172 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,141 |
1,140 |
$30K |
| D5213 |
|
70 |
70 |
$29K |
| D4342 |
|
388 |
202 |
$28K |
| D2331 |
|
357 |
261 |
$25K |
| D9239 |
|
388 |
385 |
$24K |
| D4910 |
|
298 |
298 |
$24K |
| D7310 |
|
218 |
112 |
$22K |
| D7240 |
Removal of impacted tooth - completely bony |
106 |
52 |
$17K |
| D3310 |
|
49 |
40 |
$14K |
| D2330 |
|
216 |
137 |
$11K |
| D5226 |
|
12 |
12 |
$10K |
| D5225 |
|
12 |
12 |
$8K |
| D5750 |
|
56 |
56 |
$7K |
| D7220 |
|
71 |
49 |
$6K |
| D5751 |
|
26 |
26 |
$3K |
| D5520 |
|
31 |
13 |
$2K |
| D0270 |
|
83 |
83 |
$815.88 |
| D1999 |
|
2,180 |
1,908 |
$0.00 |