| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,005 |
458 |
$93K |
| D4355 |
|
1,324 |
1,164 |
$79K |
| D1110 |
Prophylaxis - adult |
2,146 |
1,888 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,598 |
2,340 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,207 |
1,032 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,767 |
2,411 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,246 |
1,768 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,214 |
1,043 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
695 |
610 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,393 |
1,273 |
$21K |
| D1120 |
Prophylaxis - child |
528 |
498 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
216 |
202 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
136 |
98 |
$13K |
| D0330 |
Panoramic radiographic image |
288 |
222 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
82 |
62 |
$8K |
| D2160 |
|
29 |
25 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
69 |
67 |
$1K |