| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,258 |
1,420 |
$297K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,376 |
1,787 |
$290K |
| D0330 |
Panoramic radiographic image |
4,940 |
4,940 |
$220K |
| D1110 |
Prophylaxis - adult |
4,149 |
4,149 |
$199K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,978 |
4,978 |
$193K |
| D0274 |
Bitewings - four radiographic images |
5,995 |
5,995 |
$150K |
| D0220 |
Intraoral - periapical first radiographic image |
8,993 |
8,941 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,381 |
689 |
$88K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
763 |
478 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
3,586 |
3,586 |
$78K |
| D1120 |
Prophylaxis - child |
2,127 |
2,127 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,632 |
7,564 |
$72K |
| D1206 |
Topical application of fluoride varnish |
3,814 |
3,814 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,663 |
1,657 |
$60K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
97 |
79 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
656 |
339 |
$50K |
| D2332 |
|
268 |
140 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,033 |
1,033 |
$19K |
| D1351 |
Sealant - per tooth |
398 |
100 |
$12K |
| D2950 |
|
54 |
44 |
$7K |
| D2932 |
|
48 |
28 |
$7K |
| D2931 |
|
53 |
38 |
$7K |
| D0240 |
|
349 |
176 |
$5K |
| D2954 |
|
20 |
12 |
$3K |
| D2330 |
|
44 |
24 |
$2K |
| D2331 |
|
20 |
13 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$953.04 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$468.00 |