| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,509 |
845 |
$425K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,115 |
1,126 |
$329K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,363 |
802 |
$152K |
| D2394 |
|
764 |
462 |
$132K |
| D5214 |
|
91 |
91 |
$88K |
| D0274 |
Bitewings - four radiographic images |
2,775 |
2,705 |
$84K |
| D5213 |
|
83 |
83 |
$82K |
| D1110 |
Prophylaxis - adult |
1,786 |
1,752 |
$81K |
| D0330 |
Panoramic radiographic image |
1,576 |
1,560 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
4,777 |
4,629 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,737 |
2,691 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,296 |
4,303 |
$56K |
| D1120 |
Prophylaxis - child |
1,690 |
1,658 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,724 |
2,674 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,312 |
1,283 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,180 |
1,022 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
725 |
706 |
$22K |
| D1351 |
Sealant - per tooth |
576 |
146 |
$14K |
| D2335 |
|
101 |
53 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
170 |
71 |
$12K |
| D1206 |
Topical application of fluoride varnish |
411 |
400 |
$8K |
| D2332 |
|
62 |
39 |
$7K |
| D5422 |
|
135 |
116 |
$5K |
| D5421 |
|
71 |
66 |
$3K |
| D5410 |
|
68 |
52 |
$3K |
| D3120 |
|
54 |
32 |
$2K |
| D0603 |
|
16 |
16 |
$146.40 |