| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,304 |
1,174 |
$370K |
| D0210 |
Intraoral - complete series of radiographic images |
3,761 |
3,709 |
$218K |
| D1351 |
Sealant - per tooth |
6,536 |
689 |
$154K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,056 |
978 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,178 |
4,109 |
$110K |
| D1110 |
Prophylaxis - adult |
1,896 |
1,882 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,223 |
523 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
506 |
298 |
$44K |
| D2330 |
|
535 |
207 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,361 |
1,348 |
$24K |
| D1120 |
Prophylaxis - child |
788 |
783 |
$23K |
| D0330 |
Panoramic radiographic image |
339 |
332 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
823 |
817 |
$15K |
| D4341 |
|
173 |
50 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
274 |
267 |
$7K |
| D0274 |
Bitewings - four radiographic images |
253 |
253 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
556 |
548 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
105 |
26 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
471 |
459 |
$3K |
| D2335 |
|
18 |
12 |
$2K |
| D2394 |
|
16 |
12 |
$2K |
| D4355 |
|
13 |
13 |
$898.26 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$218.52 |