| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,823 |
1,218 |
$159K |
| D1120 |
Prophylaxis - child |
739 |
692 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
415 |
270 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,341 |
1,253 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
888 |
854 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
780 |
749 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
603 |
568 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,100 |
1,975 |
$13K |
| D1110 |
Prophylaxis - adult |
196 |
193 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
236 |
224 |
$7K |
| D0274 |
Bitewings - four radiographic images |
368 |
364 |
$7K |
| D4341 |
|
39 |
12 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
758 |
665 |
$4K |
| D2750 |
|
14 |
13 |
$3K |
| D1351 |
Sealant - per tooth |
39 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
26 |
$1K |
| D2950 |
|
15 |
13 |
$928.80 |
| D0272 |
Bitewings - two radiographic images |
48 |
31 |
$450.04 |
| D1206 |
Topical application of fluoride varnish |
19 |
18 |
$442.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$308.00 |