| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,077 |
945 |
$326K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,502 |
2,365 |
$321K |
| D1110 |
Prophylaxis - adult |
6,330 |
5,780 |
$282K |
| D0210 |
Intraoral - complete series of radiographic images |
4,640 |
4,005 |
$221K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,257 |
4,723 |
$184K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,995 |
1,266 |
$167K |
| D0120 |
Periodic oral evaluation - established patient |
7,860 |
7,131 |
$166K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,029 |
654 |
$146K |
| D0274 |
Bitewings - four radiographic images |
4,561 |
4,075 |
$142K |
| D0330 |
Panoramic radiographic image |
1,835 |
1,662 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
1,906 |
1,713 |
$64K |
| D7250 |
|
320 |
137 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,095 |
663 |
$62K |
| D1206 |
Topical application of fluoride varnish |
2,454 |
2,224 |
$42K |
| D4212 |
|
157 |
68 |
$41K |
| D4346 |
|
221 |
188 |
$37K |
| D2335 |
|
233 |
114 |
$37K |
| D1120 |
Prophylaxis - child |
1,506 |
1,355 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,996 |
1,785 |
$22K |
| D4341 |
|
184 |
49 |
$13K |
| D4910 |
|
127 |
103 |
$11K |
| D2332 |
|
100 |
57 |
$10K |
| D2331 |
|
60 |
37 |
$5K |
| D1999 |
|
199 |
178 |
$2K |
| D2394 |
|
14 |
13 |
$2K |
| D2330 |
|
23 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
91 |
$984.71 |
| D0230 |
Intraoral - periapical each additional radiographic image |
121 |
76 |
$925.00 |