| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,056 |
481 |
$349K |
| D9110 |
|
2,043 |
1,823 |
$127K |
| D1110 |
Prophylaxis - adult |
1,520 |
1,429 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,862 |
1,733 |
$65K |
| D0330 |
Panoramic radiographic image |
1,497 |
1,402 |
$49K |
| D7530 |
|
330 |
307 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,647 |
1,558 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
339 |
138 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
874 |
803 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
549 |
233 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
291 |
134 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,565 |
1,485 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,173 |
1,089 |
$14K |
| D4341 |
|
227 |
54 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
212 |
210 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,073 |
994 |
$3K |