| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,625 |
984 |
$303K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,585 |
4,562 |
$287K |
| D0120 |
Periodic oral evaluation - established patient |
4,634 |
4,612 |
$248K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,014 |
1,838 |
$200K |
| D0210 |
Intraoral - complete series of radiographic images |
3,543 |
3,528 |
$159K |
| D1120 |
Prophylaxis - child |
4,099 |
4,071 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,736 |
5,519 |
$119K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
205 |
166 |
$97K |
| D0274 |
Bitewings - four radiographic images |
4,561 |
4,542 |
$92K |
| D4910 |
|
1,049 |
1,041 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,302 |
815 |
$70K |
| D1351 |
Sealant - per tooth |
2,624 |
677 |
$63K |
| D9430 |
|
1,972 |
1,941 |
$62K |
| D4341 |
|
916 |
270 |
$61K |
| D2740 |
Crown - porcelain/ceramic |
114 |
100 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,750 |
4,719 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
451 |
343 |
$36K |
| D2954 |
|
267 |
217 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,935 |
1,917 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
163 |
84 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
172 |
85 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
335 |
309 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
176 |
103 |
$10K |
| D4342 |
|
202 |
67 |
$8K |
| D0350 |
|
858 |
372 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
34 |
15 |
$7K |
| D3320 |
|
15 |
14 |
$5K |
| D0272 |
Bitewings - two radiographic images |
252 |
252 |
$3K |
| D1110 |
Prophylaxis - adult |
16 |
16 |
$1K |
| D9993 |
|
82 |
82 |
$1K |
| D1310 |
|
82 |
82 |
$828.00 |
| D1999 |
|
382 |
366 |
$125.00 |
| D0603 |
|
12 |
12 |
$0.00 |