| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,961 |
1,265 |
$252K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,091 |
1,318 |
$176K |
| D0210 |
Intraoral - complete series of radiographic images |
2,556 |
2,416 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,394 |
4,139 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,973 |
835 |
$85K |
| D1110 |
Prophylaxis - adult |
2,225 |
2,065 |
$69K |
| D1351 |
Sealant - per tooth |
3,205 |
338 |
$64K |
| D0330 |
Panoramic radiographic image |
1,519 |
1,444 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
528 |
314 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,695 |
1,612 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,266 |
1,206 |
$25K |
| D1120 |
Prophylaxis - child |
753 |
713 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
879 |
843 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
652 |
627 |
$13K |
| D4341 |
|
151 |
53 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
221 |
69 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
652 |
567 |
$5K |
| D4346 |
|
45 |
43 |
$3K |
| D1206 |
Topical application of fluoride varnish |
70 |
70 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48 |
37 |
$226.09 |