| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,510 |
632 |
$274K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,515 |
823 |
$154K |
| D2394 |
|
1,050 |
706 |
$128K |
| D2335 |
|
681 |
339 |
$111K |
| D1110 |
Prophylaxis - adult |
1,847 |
1,755 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,585 |
1,494 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,084 |
947 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,965 |
1,847 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
927 |
883 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
456 |
251 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,694 |
2,488 |
$30K |
| D0274 |
Bitewings - four radiographic images |
828 |
791 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,142 |
1,090 |
$29K |
| D1351 |
Sealant - per tooth |
963 |
139 |
$27K |
| D1206 |
Topical application of fluoride varnish |
618 |
595 |
$13K |
| D1120 |
Prophylaxis - child |
245 |
230 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
95 |
39 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
68 |
24 |
$4K |
| D2332 |
|
22 |
15 |
$3K |
| D0330 |
Panoramic radiographic image |
42 |
40 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
86 |
85 |
$2K |