| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9610 |
|
11,170 |
9,634 |
$467K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,555 |
2,056 |
$322K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,954 |
2,325 |
$234K |
| D1110 |
Prophylaxis - adult |
5,251 |
4,962 |
$216K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,270 |
5,855 |
$192K |
| D0140 |
Limited oral evaluation - problem focused |
6,474 |
6,025 |
$156K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,063 |
1,351 |
$139K |
| D0210 |
Intraoral - complete series of radiographic images |
4,381 |
4,114 |
$134K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,314 |
1,234 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
3,678 |
3,465 |
$97K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
704 |
332 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
8,577 |
7,887 |
$71K |
| D1206 |
Topical application of fluoride varnish |
4,502 |
4,213 |
$62K |
| D0274 |
Bitewings - four radiographic images |
4,012 |
3,808 |
$46K |
| D4341 |
|
1,712 |
463 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,577 |
3,728 |
$20K |
| D1999 |
|
1,804 |
1,424 |
$19K |
| D0330 |
Panoramic radiographic image |
831 |
787 |
$17K |
| D2394 |
|
212 |
163 |
$13K |
| D1120 |
Prophylaxis - child |
525 |
505 |
$10K |
| D2332 |
|
153 |
99 |
$9K |
| D2335 |
|
91 |
53 |
$9K |
| D0270 |
|
867 |
828 |
$7K |
| D9992 |
|
502 |
464 |
$7K |
| D1351 |
Sealant - per tooth |
113 |
28 |
$2K |
| D2330 |
|
33 |
26 |
$2K |
| D9110 |
|
40 |
40 |
$2K |
| D0272 |
Bitewings - two radiographic images |
34 |
33 |
$358.25 |