| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,762 |
894 |
$172K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,233 |
1,081 |
$152K |
| D1110 |
Prophylaxis - adult |
2,174 |
2,034 |
$107K |
| D0140 |
Limited oral evaluation - problem focused |
3,860 |
3,439 |
$104K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
925 |
576 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,191 |
2,017 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,549 |
4,260 |
$82K |
| D4341 |
|
2,446 |
598 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,318 |
2,212 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
6,647 |
5,995 |
$61K |
| D0274 |
Bitewings - four radiographic images |
3,485 |
3,246 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
838 |
403 |
$45K |
| D0330 |
Panoramic radiographic image |
592 |
553 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,618 |
4,128 |
$14K |
| D2332 |
|
142 |
75 |
$12K |
| D1120 |
Prophylaxis - child |
480 |
444 |
$10K |
| D4346 |
|
104 |
98 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
148 |
56 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
104 |
99 |
$6K |
| D9110 |
|
99 |
86 |
$5K |
| D4910 |
|
94 |
93 |
$4K |
| D9920 |
|
136 |
122 |
$3K |
| D1351 |
Sealant - per tooth |
148 |
30 |
$3K |
| D1999 |
|
261 |
192 |
$2K |
| D2331 |
|
18 |
12 |
$2K |
| D2330 |
|
18 |
12 |
$1K |