| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,789 |
509 |
$174K |
| D9610 |
|
1,302 |
1,063 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,494 |
1,270 |
$58K |
| D1110 |
Prophylaxis - adult |
1,242 |
1,092 |
$56K |
| D0330 |
Panoramic radiographic image |
1,510 |
1,280 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
567 |
319 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,029 |
869 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,188 |
1,064 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,804 |
1,550 |
$24K |
| D4341 |
|
606 |
202 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
741 |
678 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
361 |
214 |
$20K |
| D7240 |
Removal of impacted tooth - completely bony |
94 |
29 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
166 |
107 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
751 |
617 |
$7K |
| D1120 |
Prophylaxis - child |
215 |
189 |
$4K |
| D4346 |
|
50 |
48 |
$3K |
| D9239 |
|
13 |
13 |
$700.00 |
| D9243 |
|
39 |
13 |
$700.00 |
| D0272 |
Bitewings - two radiographic images |
65 |
60 |
$607.18 |
| D1206 |
Topical application of fluoride varnish |
28 |
24 |
$439.57 |