| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,722 |
1,860 |
$284K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,956 |
975 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,168 |
3,848 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,282 |
551 |
$68K |
| D1120 |
Prophylaxis - child |
1,725 |
1,656 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,685 |
752 |
$64K |
| D0330 |
Panoramic radiographic image |
2,303 |
2,181 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,992 |
1,905 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
1,532 |
1,359 |
$35K |
| D4341 |
|
198 |
88 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,540 |
1,446 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,017 |
1,002 |
$25K |
| D8670 |
Periodic orthodontic treatment visit |
56 |
54 |
$12K |
| D1110 |
Prophylaxis - adult |
360 |
332 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
110 |
83 |
$7K |
| D0274 |
Bitewings - four radiographic images |
440 |
414 |
$7K |
| D5110 |
|
13 |
12 |
$5K |
| D1206 |
Topical application of fluoride varnish |
290 |
266 |
$4K |
| D1351 |
Sealant - per tooth |
80 |
27 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
743 |
704 |
$3K |
| D9110 |
|
49 |
48 |
$3K |
| D0272 |
Bitewings - two radiographic images |
173 |
156 |
$2K |
| D2940 |
|
84 |
42 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46 |
39 |
$110.20 |