| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,753 |
1,255 |
$303K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,480 |
1,566 |
$262K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,600 |
1,523 |
$204K |
| D1110 |
Prophylaxis - adult |
5,335 |
5,116 |
$202K |
| D0140 |
Limited oral evaluation - problem focused |
4,437 |
4,060 |
$157K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,179 |
827 |
$150K |
| D0210 |
Intraoral - complete series of radiographic images |
1,831 |
1,753 |
$130K |
| D2335 |
|
945 |
529 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
4,111 |
3,953 |
$99K |
| D2332 |
|
1,011 |
622 |
$97K |
| D0330 |
Panoramic radiographic image |
1,471 |
1,412 |
$85K |
| D2394 |
|
443 |
311 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,576 |
1,512 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,077 |
1,982 |
$65K |
| D2330 |
|
728 |
473 |
$48K |
| D4355 |
|
685 |
644 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,133 |
1,988 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,803 |
1,733 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,096 |
466 |
$13K |
| D2331 |
|
92 |
63 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
15 |
$3K |
| D1120 |
Prophylaxis - child |
74 |
68 |
$2K |
| D9110 |
|
18 |
14 |
$623.28 |
| D0272 |
Bitewings - two radiographic images |
16 |
12 |
$190.49 |