| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,990 |
1,879 |
$398K |
| D4341 |
|
2,191 |
1,269 |
$334K |
| D0120 |
Periodic oral evaluation - established patient |
3,012 |
2,930 |
$83K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
740 |
423 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
949 |
617 |
$71K |
| D1120 |
Prophylaxis - child |
1,601 |
1,540 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,322 |
2,228 |
$57K |
| D0330 |
Panoramic radiographic image |
2,069 |
2,038 |
$43K |
| D1110 |
Prophylaxis - adult |
833 |
826 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,463 |
1,406 |
$38K |
| D5110 |
|
88 |
86 |
$38K |
| D1351 |
Sealant - per tooth |
576 |
231 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
1,075 |
987 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,226 |
1,177 |
$21K |
| D0272 |
Bitewings - two radiographic images |
2,145 |
2,053 |
$19K |
| D5120 |
|
35 |
33 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
172 |
71 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
602 |
585 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,291 |
1,230 |
$7K |
| D2950 |
|
90 |
78 |
$5K |
| D2740 |
Crown - porcelain/ceramic |
18 |
12 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
74 |
58 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
27 |
$175.63 |