| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,370 |
2,175 |
$398K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,499 |
3,435 |
$353K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,444 |
3,061 |
$328K |
| D0210 |
Intraoral - complete series of radiographic images |
6,029 |
5,538 |
$224K |
| D1110 |
Prophylaxis - adult |
5,815 |
5,400 |
$174K |
| D0330 |
Panoramic radiographic image |
3,798 |
3,473 |
$168K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,255 |
7,577 |
$163K |
| D1351 |
Sealant - per tooth |
9,033 |
1,361 |
$152K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,808 |
1,195 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
6,368 |
5,783 |
$97K |
| D0274 |
Bitewings - four radiographic images |
4,704 |
4,340 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,460 |
5,052 |
$76K |
| D1120 |
Prophylaxis - child |
2,700 |
2,457 |
$61K |
| D4355 |
|
1,055 |
978 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
3,231 |
2,989 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
6,662 |
6,110 |
$58K |
| D2330 |
|
709 |
324 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
386 |
283 |
$25K |
| D2331 |
|
439 |
280 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,350 |
2,860 |
$21K |
| D0272 |
Bitewings - two radiographic images |
520 |
479 |
$6K |
| D5110 |
|
19 |
13 |
$6K |
| D2332 |
|
85 |
44 |
$4K |
| D1206 |
Topical application of fluoride varnish |
256 |
206 |
$3K |
| D7230 |
|
20 |
14 |
$3K |
| D2335 |
|
48 |
25 |
$3K |
| D4341 |
|
45 |
13 |
$2K |
| D0270 |
|
20 |
13 |
$98.77 |