| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,008 |
2,380 |
$418K |
| D1110 |
Prophylaxis - adult |
4,302 |
4,285 |
$345K |
| D0140 |
Limited oral evaluation - problem focused |
6,529 |
6,378 |
$291K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,352 |
3,307 |
$249K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,834 |
2,315 |
$241K |
| D7230 |
|
661 |
592 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
3,233 |
3,223 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
681 |
595 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
2,350 |
2,304 |
$60K |
| D7220 |
|
444 |
401 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
529 |
382 |
$49K |
| D0330 |
Panoramic radiographic image |
1,759 |
1,747 |
$37K |
| D7240 |
Removal of impacted tooth - completely bony |
205 |
166 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,455 |
1,454 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
4,201 |
4,115 |
$27K |
| D1120 |
Prophylaxis - child |
739 |
737 |
$26K |
| D1206 |
Topical application of fluoride varnish |
773 |
773 |
$19K |
| D7250 |
|
146 |
64 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,870 |
1,809 |
$10K |
| D4355 |
|
58 |
57 |
$6K |
| D4341 |
|
23 |
12 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
56 |
56 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
77 |
77 |
$473.56 |
| D0191 |
|
61 |
58 |
$324.24 |
| 0001F |
|
185 |
172 |
$237.60 |