| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,834 |
811 |
$178K |
| D4341 |
|
873 |
474 |
$123K |
| D1120 |
Prophylaxis - child |
994 |
979 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,474 |
1,445 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,180 |
1,165 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
966 |
954 |
$26K |
| D0330 |
Panoramic radiographic image |
1,056 |
1,037 |
$25K |
| D1110 |
Prophylaxis - adult |
464 |
457 |
$22K |
| D1351 |
Sealant - per tooth |
376 |
101 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
225 |
154 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
135 |
87 |
$13K |
| D0274 |
Bitewings - four radiographic images |
545 |
528 |
$10K |
| D0272 |
Bitewings - two radiographic images |
929 |
923 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
343 |
343 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
226 |
209 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
741 |
684 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
32 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
293 |
256 |
$1K |