| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,933 |
525 |
$133K |
| D1110 |
Prophylaxis - adult |
3,335 |
3,281 |
$125K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,128 |
1,134 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,648 |
1,087 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
5,203 |
5,136 |
$85K |
| D1120 |
Prophylaxis - child |
2,559 |
2,538 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,168 |
392 |
$51K |
| D9630 |
|
2,887 |
2,849 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
3,096 |
2,335 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,944 |
1,524 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,858 |
1,830 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,964 |
1,961 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,068 |
2,028 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,549 |
2,617 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
277 |
272 |
$18K |
| D0330 |
Panoramic radiographic image |
496 |
342 |
$17K |
| D0272 |
Bitewings - two radiographic images |
786 |
774 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
101 |
88 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
956 |
507 |
$7K |
| D1351 |
Sealant - per tooth |
40 |
12 |
$1K |
| D1330 |
|
68 |
68 |
$0.00 |