| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,775 |
1,020 |
$252K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,290 |
749 |
$56K |
| D7310 |
|
324 |
123 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
849 |
537 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,006 |
1,888 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
1,697 |
1,602 |
$38K |
| D1110 |
Prophylaxis - adult |
1,146 |
1,104 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,842 |
1,658 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,374 |
1,331 |
$26K |
| D4341 |
|
1,005 |
264 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,492 |
1,430 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
506 |
287 |
$17K |
| D7240 |
Removal of impacted tooth - completely bony |
122 |
41 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,433 |
2,309 |
$15K |
| D0274 |
Bitewings - four radiographic images |
1,568 |
1,506 |
$12K |
| D2335 |
|
151 |
68 |
$10K |
| D0330 |
Panoramic radiographic image |
1,780 |
1,665 |
$6K |
| D2332 |
|
101 |
59 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,975 |
1,660 |
$5K |
| D2394 |
|
69 |
53 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
124 |
26 |
$3K |
| D1120 |
Prophylaxis - child |
117 |
109 |
$2K |
| D2331 |
|
48 |
30 |
$2K |
| D2330 |
|
28 |
13 |
$829.66 |
| D0270 |
|
143 |
136 |
$561.60 |
| D0160 |
|
13 |
12 |
$431.80 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19 |
17 |
$340.00 |