| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,645 |
1,061 |
$210K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,205 |
1,271 |
$191K |
| D0330 |
Panoramic radiographic image |
3,779 |
3,779 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,829 |
3,829 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,775 |
1,021 |
$135K |
| D1110 |
Prophylaxis - adult |
2,071 |
2,071 |
$101K |
| D0274 |
Bitewings - four radiographic images |
3,822 |
3,822 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
5,137 |
5,110 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,167 |
1,157 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,225 |
4,208 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
361 |
280 |
$39K |
| D2332 |
|
392 |
263 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
984 |
984 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,201 |
1,201 |
$20K |
| D2330 |
|
205 |
142 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
155 |
79 |
$13K |
| D1120 |
Prophylaxis - child |
333 |
333 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
16 |
$9K |
| D2950 |
|
49 |
41 |
$6K |
| D2335 |
|
51 |
37 |
$6K |
| D7250 |
|
29 |
14 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
95 |
87 |
$3K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$450.88 |