| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,702 |
1,220 |
$232K |
| D0274 |
Bitewings - four radiographic images |
6,921 |
6,584 |
$191K |
| D1110 |
Prophylaxis - adult |
5,702 |
5,362 |
$185K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,047 |
4,251 |
$171K |
| D0140 |
Limited oral evaluation - problem focused |
6,656 |
5,173 |
$157K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,435 |
7,085 |
$134K |
| D0220 |
Intraoral - periapical first radiographic image |
12,922 |
6,021 |
$130K |
| D0330 |
Panoramic radiographic image |
3,073 |
2,467 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,525 |
920 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
4,064 |
3,868 |
$88K |
| D1120 |
Prophylaxis - child |
1,933 |
1,916 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,221 |
699 |
$71K |
| D7250 |
|
467 |
190 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,683 |
2,485 |
$43K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
83 |
67 |
$39K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
73 |
45 |
$35K |
| D9944 |
|
98 |
98 |
$33K |
| D9945 |
|
111 |
110 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
246 |
91 |
$16K |
| D1351 |
Sealant - per tooth |
251 |
54 |
$10K |
| D2954 |
|
54 |
43 |
$8K |
| D3320 |
|
19 |
15 |
$6K |
| D2791 |
|
14 |
12 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
56 |
43 |
$5K |
| D2140 |
|
80 |
47 |
$4K |
| D1206 |
Topical application of fluoride varnish |
37 |
36 |
$698.32 |