| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,193 |
2,095 |
$595K |
| D0140 |
Limited oral evaluation - problem focused |
3,773 |
3,462 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,532 |
2,408 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,284 |
604 |
$64K |
| D4341 |
|
2,062 |
673 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
739 |
439 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
4,558 |
4,079 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
1,067 |
1,001 |
$42K |
| D1110 |
Prophylaxis - adult |
901 |
867 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,226 |
1,181 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
575 |
550 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,926 |
2,182 |
$15K |
| D1999 |
|
1,241 |
905 |
$14K |
| D1206 |
Topical application of fluoride varnish |
608 |
584 |
$13K |
| D9110 |
|
274 |
250 |
$12K |
| D0274 |
Bitewings - four radiographic images |
779 |
756 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
92 |
69 |
$10K |
| D2332 |
|
83 |
46 |
$6K |
| D1120 |
Prophylaxis - child |
121 |
119 |
$3K |
| D4910 |
|
16 |
16 |
$1K |