| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,392 |
753 |
$204K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
439 |
340 |
$150K |
| D0210 |
Intraoral - complete series of radiographic images |
2,247 |
2,049 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,574 |
672 |
$91K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,160 |
617 |
$84K |
| D2394 |
|
782 |
531 |
$62K |
| D1110 |
Prophylaxis - adult |
1,869 |
1,680 |
$55K |
| D3320 |
|
236 |
163 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,415 |
2,183 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
773 |
355 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,374 |
1,226 |
$28K |
| D1120 |
Prophylaxis - child |
873 |
815 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,220 |
1,052 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
374 |
155 |
$17K |
| D2335 |
|
209 |
101 |
$15K |
| D0274 |
Bitewings - four radiographic images |
616 |
539 |
$10K |
| D0330 |
Panoramic radiographic image |
445 |
360 |
$9K |
| D4341 |
|
78 |
27 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
878 |
734 |
$7K |
| D1351 |
Sealant - per tooth |
336 |
32 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
381 |
355 |
$6K |
| D9110 |
|
118 |
100 |
$3K |
| D2931 |
|
22 |
14 |
$2K |
| D0270 |
|
194 |
181 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46 |
26 |
$257.16 |