| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
457 |
195 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
834 |
317 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
1,167 |
866 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,182 |
1,016 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
454 |
202 |
$22K |
| D1110 |
Prophylaxis - adult |
404 |
350 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
203 |
104 |
$16K |
| D0274 |
Bitewings - four radiographic images |
428 |
377 |
$12K |
| D0330 |
Panoramic radiographic image |
361 |
308 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
584 |
504 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,037 |
910 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
455 |
415 |
$10K |
| D1351 |
Sealant - per tooth |
444 |
47 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
906 |
736 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
237 |
205 |
$7K |
| D1120 |
Prophylaxis - child |
257 |
235 |
$6K |
| D2332 |
|
61 |
26 |
$6K |
| D4346 |
|
15 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
71 |
67 |
$1K |