| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,027 |
648 |
$100K |
| D4341 |
|
231 |
107 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,652 |
1,467 |
$31K |
| D9110 |
|
550 |
537 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
858 |
820 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
628 |
614 |
$20K |
| D1120 |
Prophylaxis - child |
475 |
457 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
673 |
663 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,896 |
1,797 |
$12K |
| D0330 |
Panoramic radiographic image |
364 |
363 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,364 |
1,145 |
$8K |
| D0274 |
Bitewings - four radiographic images |
418 |
414 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
221 |
215 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
100 |
43 |
$4K |
| D1351 |
Sealant - per tooth |
36 |
13 |
$3K |
| D1110 |
Prophylaxis - adult |
62 |
61 |
$2K |
| D2950 |
|
17 |
14 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
14 |
$965.94 |