| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
6,064 |
1,336 |
$701K |
| D0210 |
Intraoral - complete series of radiographic images |
1,563 |
1,563 |
$137K |
| D0330 |
Panoramic radiographic image |
3,224 |
3,223 |
$113K |
| D1110 |
Prophylaxis - adult |
1,937 |
1,937 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,494 |
865 |
$95K |
| D4341 |
|
884 |
315 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
376 |
247 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,914 |
1,904 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,516 |
2,515 |
$17K |
| D2394 |
|
58 |
42 |
$13K |
| D4910 |
|
121 |
120 |
$9K |
| D0274 |
Bitewings - four radiographic images |
3,041 |
3,041 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
323 |
222 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
340 |
80 |
$2K |
| D4342 |
|
39 |
13 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
1,028 |
1,028 |
$2K |
| D4346 |
|
13 |
13 |
$1K |
| D1120 |
Prophylaxis - child |
47 |
47 |
$1K |
| D1351 |
Sealant - per tooth |
94 |
13 |
$208.30 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,689 |
1,689 |
$134.36 |
| D0220 |
Intraoral - periapical first radiographic image |
1,679 |
1,662 |
$59.08 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$14.84 |