| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,804 |
833 |
$460K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,853 |
648 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,526 |
416 |
$146K |
| D1110 |
Prophylaxis - adult |
1,985 |
1,940 |
$91K |
| D0330 |
Panoramic radiographic image |
2,135 |
2,112 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
3,312 |
3,256 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,603 |
2,523 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,218 |
2,133 |
$66K |
| D1206 |
Topical application of fluoride varnish |
3,665 |
3,590 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
886 |
821 |
$60K |
| D1120 |
Prophylaxis - child |
1,719 |
1,686 |
$56K |
| D0272 |
Bitewings - two radiographic images |
1,653 |
1,621 |
$34K |
| D2140 |
|
489 |
236 |
$30K |
| D4341 |
|
210 |
94 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
183 |
86 |
$22K |
| D2332 |
|
151 |
73 |
$16K |
| D2160 |
|
106 |
57 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
151 |
84 |
$9K |
| D1351 |
Sealant - per tooth |
172 |
48 |
$4K |
| D0601 |
|
677 |
654 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
56 |
$2K |
| D0603 |
|
242 |
240 |
$2K |
| D0602 |
|
165 |
162 |
$945.95 |