| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,789 |
2,097 |
$417K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,084 |
2,672 |
$369K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,250 |
10,222 |
$354K |
| D0274 |
Bitewings - four radiographic images |
7,223 |
7,192 |
$200K |
| D0140 |
Limited oral evaluation - problem focused |
6,282 |
6,193 |
$181K |
| D1110 |
Prophylaxis - adult |
3,954 |
3,936 |
$178K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,664 |
967 |
$145K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,799 |
713 |
$119K |
| D0220 |
Intraoral - periapical first radiographic image |
10,419 |
9,998 |
$117K |
| D0330 |
Panoramic radiographic image |
2,332 |
2,325 |
$112K |
| D2394 |
|
796 |
515 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,082 |
534 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,576 |
2,574 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
830 |
812 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,019 |
3,701 |
$38K |
| D4341 |
|
188 |
69 |
$23K |
| D1120 |
Prophylaxis - child |
445 |
445 |
$14K |
| D9110 |
|
257 |
253 |
$14K |
| D2335 |
|
109 |
63 |
$13K |
| D5214 |
|
12 |
12 |
$10K |
| D0270 |
|
636 |
628 |
$6K |
| D1206 |
Topical application of fluoride varnish |
264 |
264 |
$4K |
| D2332 |
|
23 |
13 |
$3K |