| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,128 |
638 |
$205K |
| D1110 |
Prophylaxis - adult |
3,608 |
3,453 |
$193K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,215 |
1,306 |
$181K |
| D0210 |
Intraoral - complete series of radiographic images |
2,433 |
2,173 |
$140K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,212 |
3,031 |
$128K |
| D1351 |
Sealant - per tooth |
4,540 |
644 |
$126K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,150 |
777 |
$119K |
| D7140 |
Extraction, erupted tooth or exposed root |
997 |
324 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,399 |
3,445 |
$77K |
| D0274 |
Bitewings - four radiographic images |
1,766 |
1,685 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,393 |
2,302 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,394 |
1,287 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
852 |
539 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
4,819 |
4,418 |
$51K |
| D1206 |
Topical application of fluoride varnish |
1,791 |
1,728 |
$39K |
| D1120 |
Prophylaxis - child |
1,039 |
1,004 |
$36K |
| D2394 |
|
231 |
171 |
$29K |
| D2335 |
|
141 |
96 |
$23K |
| D2332 |
|
91 |
63 |
$11K |
| D0272 |
Bitewings - two radiographic images |
118 |
106 |
$3K |
| D0270 |
|
153 |
145 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
59 |
56 |
$1K |