| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
11,343 |
3,924 |
$1.18M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,171 |
2,657 |
$378K |
| D4341 |
|
9,359 |
2,392 |
$309K |
| D0140 |
Limited oral evaluation - problem focused |
11,067 |
9,230 |
$294K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,784 |
2,277 |
$266K |
| D0210 |
Intraoral - complete series of radiographic images |
5,398 |
5,352 |
$230K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,036 |
5,979 |
$223K |
| D1110 |
Prophylaxis - adult |
4,516 |
4,483 |
$218K |
| D2332 |
|
2,337 |
1,303 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
4,365 |
4,345 |
$128K |
| D0220 |
Intraoral - periapical first radiographic image |
10,495 |
9,998 |
$95K |
| D0274 |
Bitewings - four radiographic images |
4,289 |
4,257 |
$58K |
| D4910 |
|
866 |
857 |
$56K |
| D1351 |
Sealant - per tooth |
2,711 |
475 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,729 |
7,832 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,686 |
2,673 |
$49K |
| D2160 |
|
517 |
387 |
$31K |
| D1120 |
Prophylaxis - child |
1,266 |
1,257 |
$30K |
| D1999 |
|
4,410 |
3,520 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
404 |
254 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
306 |
215 |
$16K |
| D2335 |
|
165 |
111 |
$14K |
| D9110 |
|
184 |
179 |
$14K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,586 |
1,581 |
$8K |
| D2394 |
|
110 |
97 |
$8K |