| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,576 |
570 |
$153K |
| D1110 |
Prophylaxis - adult |
3,838 |
3,617 |
$151K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,638 |
695 |
$128K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,850 |
636 |
$127K |
| D0274 |
Bitewings - four radiographic images |
2,989 |
2,799 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,687 |
2,491 |
$72K |
| D1351 |
Sealant - per tooth |
2,815 |
298 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
3,170 |
2,998 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
2,467 |
2,244 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
763 |
385 |
$55K |
| D0330 |
Panoramic radiographic image |
963 |
903 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,423 |
3,047 |
$38K |
| D1120 |
Prophylaxis - child |
928 |
882 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,350 |
1,277 |
$24K |
| D5110 |
|
29 |
24 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
152 |
93 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,212 |
656 |
$10K |
| D0272 |
Bitewings - two radiographic images |
45 |
44 |
$980.76 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$763.20 |
| D9630 |
|
214 |
175 |
$0.00 |