| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,967 |
483 |
$324K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,024 |
1,663 |
$224K |
| D1110 |
Prophylaxis - adult |
3,514 |
3,277 |
$162K |
| D0210 |
Intraoral - complete series of radiographic images |
2,606 |
2,323 |
$147K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,431 |
879 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,335 |
3,108 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
4,865 |
4,514 |
$105K |
| D0140 |
Limited oral evaluation - problem focused |
2,703 |
2,516 |
$91K |
| D1206 |
Topical application of fluoride varnish |
4,319 |
3,995 |
$82K |
| D1120 |
Prophylaxis - child |
2,581 |
2,399 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,250 |
730 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
874 |
341 |
$68K |
| D1351 |
Sealant - per tooth |
2,249 |
223 |
$59K |
| D0330 |
Panoramic radiographic image |
1,342 |
1,250 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,757 |
1,645 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
2,617 |
2,346 |
$30K |
| D2331 |
|
180 |
119 |
$18K |
| D2332 |
|
135 |
79 |
$14K |
| D2335 |
|
78 |
39 |
$13K |
| D0272 |
Bitewings - two radiographic images |
443 |
415 |
$9K |
| D2394 |
|
70 |
53 |
$8K |
| D2330 |
|
36 |
28 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
272 |
185 |
$3K |
| D4346 |
|
26 |
24 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
184 |
155 |
$963.16 |
| D1999 |
|
535 |
424 |
$812.26 |