| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,957 |
841 |
$199K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,883 |
995 |
$191K |
| D9110 |
|
3,141 |
2,558 |
$129K |
| D0140 |
Limited oral evaluation - problem focused |
3,104 |
2,401 |
$104K |
| D7310 |
|
843 |
550 |
$83K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
631 |
448 |
$77K |
| D2331 |
|
871 |
491 |
$68K |
| D4355 |
|
904 |
887 |
$58K |
| D1110 |
Prophylaxis - adult |
1,626 |
1,577 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
695 |
480 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,869 |
1,825 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,762 |
2,595 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,268 |
1,247 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
961 |
940 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,207 |
2,177 |
$38K |
| D0330 |
Panoramic radiographic image |
733 |
707 |
$37K |
| D7311 |
|
352 |
284 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,206 |
1,183 |
$19K |
| D2332 |
|
214 |
142 |
$19K |
| D1120 |
Prophylaxis - child |
699 |
687 |
$18K |
| D2335 |
|
77 |
53 |
$9K |
| D2330 |
|
137 |
94 |
$8K |
| D0272 |
Bitewings - two radiographic images |
442 |
432 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
42 |
$5K |
| D2951 |
|
185 |
93 |
$4K |
| D4341 |
|
52 |
19 |
$4K |
| D5650 |
|
52 |
14 |
$2K |
| D5612 |
|
17 |
13 |
$1K |
| D5421 |
|
29 |
26 |
$686.52 |
| D5410 |
|
20 |
16 |
$595.68 |
| D5422 |
|
17 |
15 |
$465.64 |
| D0170 |
|
15 |
15 |
$444.75 |