| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,453 |
1,448 |
$160K |
| D0210 |
Intraoral - complete series of radiographic images |
2,695 |
2,529 |
$142K |
| D0140 |
Limited oral evaluation - problem focused |
4,084 |
3,678 |
$120K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,532 |
753 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,716 |
2,530 |
$76K |
| D1120 |
Prophylaxis - child |
1,845 |
1,722 |
$75K |
| D0330 |
Panoramic radiographic image |
2,152 |
2,031 |
$63K |
| D1206 |
Topical application of fluoride varnish |
1,362 |
1,294 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,828 |
3,454 |
$43K |
| D0274 |
Bitewings - four radiographic images |
2,065 |
1,878 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
965 |
471 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,670 |
3,678 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,738 |
1,607 |
$33K |
| D1351 |
Sealant - per tooth |
810 |
102 |
$15K |
| D5214 |
|
31 |
25 |
$13K |
| D8660 |
|
272 |
259 |
$12K |
| D1110 |
Prophylaxis - adult |
463 |
426 |
$11K |
| D0270 |
|
1,000 |
881 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
214 |
113 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
269 |
240 |
$2K |
| D7250 |
|
38 |
12 |
$2K |
| D0340 |
|
41 |
40 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
25 |
25 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
41 |
41 |
$1K |
| D0470 |
|
41 |
40 |
$819.84 |
| D0350 |
|
128 |
115 |
$697.00 |
| D1999 |
|
33 |
33 |
$495.00 |