| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,149 |
525 |
$130K |
| D9243 |
|
211 |
204 |
$66K |
| D1110 |
Prophylaxis - adult |
1,708 |
1,702 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
933 |
586 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,935 |
1,929 |
$52K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
110 |
109 |
$50K |
| D0330 |
Panoramic radiographic image |
1,094 |
1,089 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,700 |
1,697 |
$33K |
| D1351 |
Sealant - per tooth |
1,280 |
206 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
451 |
323 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
584 |
387 |
$28K |
| D9239 |
|
210 |
204 |
$27K |
| D1330 |
|
1,783 |
1,777 |
$20K |
| D1310 |
|
1,785 |
1,779 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
997 |
993 |
$19K |
| D9222 |
|
110 |
109 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
687 |
683 |
$13K |
| D7240 |
Removal of impacted tooth - completely bony |
49 |
14 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
153 |
89 |
$10K |
| D2394 |
|
148 |
120 |
$10K |
| D1120 |
Prophylaxis - child |
264 |
263 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
867 |
857 |
$6K |
| D2332 |
|
64 |
44 |
$4K |
| D4346 |
|
78 |
78 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
249 |
245 |
$3K |
| D2335 |
|
26 |
16 |
$2K |
| D9110 |
|
40 |
40 |
$1K |
| D1206 |
Topical application of fluoride varnish |
17 |
17 |
$316.42 |