| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
8,534 |
1,920 |
$1.06M |
| D2394 |
|
2,628 |
1,457 |
$696K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,321 |
2,388 |
$419K |
| D0210 |
Intraoral - complete series of radiographic images |
3,046 |
3,046 |
$346K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,443 |
2,798 |
$148K |
| D1110 |
Prophylaxis - adult |
3,120 |
3,120 |
$147K |
| D0330 |
Panoramic radiographic image |
3,889 |
3,877 |
$56K |
| D4341 |
|
380 |
135 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,571 |
1,540 |
$24K |
| D4910 |
|
198 |
198 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,988 |
3,986 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,421 |
773 |
$16K |
| D4342 |
|
272 |
96 |
$11K |
| D2331 |
|
285 |
200 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,460 |
285 |
$8K |
| D2332 |
|
90 |
50 |
$6K |
| D2330 |
|
350 |
227 |
$6K |
| D0274 |
Bitewings - four radiographic images |
4,578 |
4,573 |
$4K |
| D1999 |
|
1,854 |
1,698 |
$699.35 |
| D0120 |
Periodic oral evaluation - established patient |
1,239 |
1,235 |
$461.57 |
| D0220 |
Intraoral - periapical first radiographic image |
6,163 |
5,996 |
$151.48 |
| D1208 |
Topical application of fluoride, excluding varnish |
3,629 |
3,628 |
$40.65 |
| D9986 |
|
74 |
74 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,739 |
4,931 |
$0.00 |