| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,680 |
1,086 |
$407K |
| D1110 |
Prophylaxis - adult |
3,618 |
3,453 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,559 |
978 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
2,934 |
2,749 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
4,414 |
4,221 |
$92K |
| D0330 |
Panoramic radiographic image |
1,241 |
1,168 |
$70K |
| D1206 |
Topical application of fluoride varnish |
2,286 |
2,186 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,841 |
1,753 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,024 |
977 |
$36K |
| D1120 |
Prophylaxis - child |
1,069 |
1,036 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,111 |
1,973 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
230 |
185 |
$20K |
| D2332 |
|
144 |
82 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
231 |
169 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
326 |
316 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
17 |
$4K |
| D2331 |
|
18 |
14 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
234 |
211 |
$358.24 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$141.00 |