| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,544 |
1,178 |
$187K |
| D1351 |
Sealant - per tooth |
2,881 |
994 |
$149K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,251 |
667 |
$137K |
| D1110 |
Prophylaxis - adult |
3,221 |
3,007 |
$123K |
| D1120 |
Prophylaxis - child |
2,786 |
2,657 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
3,840 |
3,515 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,772 |
2,645 |
$65K |
| D0330 |
Panoramic radiographic image |
3,152 |
2,997 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,957 |
2,811 |
$60K |
| D5110 |
|
160 |
150 |
$56K |
| D5120 |
|
101 |
91 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
4,896 |
4,644 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,311 |
1,228 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
1,761 |
1,696 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,288 |
3,053 |
$10K |
| D4341 |
|
51 |
25 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
67 |
37 |
$3K |
| D2332 |
|
55 |
29 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
31 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
121 |
120 |
$2K |
| D0272 |
Bitewings - two radiographic images |
163 |
157 |
$1K |
| D1999 |
|
832 |
700 |
$0.00 |