| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,253 |
2,470 |
$1.09M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,326 |
1,172 |
$666K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,781 |
3,706 |
$467K |
| D1110 |
Prophylaxis - adult |
8,869 |
8,407 |
$399K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,144 |
2,481 |
$355K |
| D2335 |
|
2,110 |
1,015 |
$309K |
| D0210 |
Intraoral - complete series of radiographic images |
5,693 |
4,827 |
$291K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,823 |
1,310 |
$281K |
| D0140 |
Limited oral evaluation - problem focused |
7,908 |
7,309 |
$272K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,819 |
6,333 |
$243K |
| D2394 |
|
2,091 |
1,314 |
$226K |
| D0120 |
Periodic oral evaluation - established patient |
9,856 |
9,323 |
$208K |
| D2332 |
|
1,781 |
1,015 |
$185K |
| D0330 |
Panoramic radiographic image |
3,793 |
3,542 |
$163K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,265 |
2,049 |
$160K |
| D0274 |
Bitewings - four radiographic images |
4,905 |
4,614 |
$154K |
| D1206 |
Topical application of fluoride varnish |
7,127 |
6,670 |
$122K |
| D1120 |
Prophylaxis - child |
3,500 |
3,296 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
7,032 |
6,321 |
$78K |
| D7250 |
|
325 |
122 |
$64K |
| D5110 |
|
89 |
79 |
$39K |
| D7240 |
Removal of impacted tooth - completely bony |
113 |
41 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,384 |
1,280 |
$27K |
| D3320 |
|
71 |
60 |
$27K |
| D1351 |
Sealant - per tooth |
904 |
148 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,578 |
1,577 |
$21K |
| D2331 |
|
170 |
125 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
594 |
512 |
$12K |
| D9248 |
|
465 |
422 |
$11K |
| D3310 |
|
20 |
12 |
$8K |
| D5120 |
|
13 |
13 |
$7K |
| D2330 |
|
79 |
61 |
$5K |
| D2931 |
|
140 |
124 |
$2K |
| D4346 |
|
20 |
13 |
$2K |
| D1999 |
|
1,102 |
899 |
$1K |
| D2949 |
|
133 |
113 |
$1K |
| D0270 |
|
35 |
31 |
$473.86 |
| D1208 |
Topical application of fluoride, excluding varnish |
21 |
21 |
$22.39 |