| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,010 |
960 |
$286K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,437 |
981 |
$167K |
| D0210 |
Intraoral - complete series of radiographic images |
2,939 |
2,234 |
$139K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,219 |
567 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,629 |
2,339 |
$91K |
| D1110 |
Prophylaxis - adult |
1,077 |
993 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
876 |
437 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,034 |
939 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
987 |
868 |
$31K |
| D7250 |
|
148 |
60 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,041 |
948 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
222 |
62 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,164 |
1,903 |
$21K |
| D4346 |
|
123 |
114 |
$21K |
| D2335 |
|
134 |
70 |
$20K |
| D0330 |
Panoramic radiographic image |
651 |
572 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
885 |
814 |
$16K |
| D2394 |
|
181 |
72 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,636 |
1,379 |
$15K |
| D1351 |
Sealant - per tooth |
616 |
85 |
$15K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
160 |
55 |
$12K |
| D1120 |
Prophylaxis - child |
458 |
407 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
184 |
51 |
$10K |
| D2332 |
|
99 |
50 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
295 |
239 |
$4K |
| D0272 |
Bitewings - two radiographic images |
189 |
154 |
$3K |
| D9248 |
|
94 |
77 |
$2K |
| D9920 |
|
74 |
48 |
$1K |
| D1999 |
|
17 |
14 |
$0.00 |