| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,216 |
349 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
723 |
644 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,087 |
948 |
$31K |
| D1120 |
Prophylaxis - child |
536 |
461 |
$20K |
| D1206 |
Topical application of fluoride varnish |
531 |
456 |
$16K |
| D1351 |
Sealant - per tooth |
889 |
134 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
365 |
321 |
$9K |
| D0274 |
Bitewings - four radiographic images |
437 |
382 |
$8K |
| D1110 |
Prophylaxis - adult |
404 |
368 |
$7K |
| D0330 |
Panoramic radiographic image |
220 |
178 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
135 |
47 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
702 |
611 |
$6K |
| D0350 |
|
348 |
293 |
$5K |
| D2140 |
|
93 |
41 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
73 |
31 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
840 |
641 |
$3K |
| D2160 |
|
38 |
12 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
136 |
109 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
17 |
$1K |
| D0170 |
|
91 |
87 |
$1K |
| D0601 |
|
350 |
295 |
$1K |
| D4355 |
|
38 |
29 |
$945.00 |
| D0160 |
|
30 |
25 |
$450.00 |
| D9110 |
|
20 |
14 |
$238.00 |
| D9210 |
|
67 |
45 |
$205.00 |
| D9310 |
|
93 |
74 |
$40.00 |
| D9215 |
|
218 |
152 |
$18.45 |