| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,537 |
658 |
$142K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,770 |
681 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,093 |
2,020 |
$50K |
| D4341 |
|
1,957 |
509 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
2,058 |
1,866 |
$36K |
| D1110 |
Prophylaxis - adult |
1,066 |
1,036 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
1,121 |
1,084 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,303 |
1,284 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
473 |
217 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,355 |
2,263 |
$15K |
| D0274 |
Bitewings - four radiographic images |
1,518 |
1,475 |
$14K |
| D0330 |
Panoramic radiographic image |
694 |
670 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,006 |
985 |
$12K |
| D2332 |
|
197 |
87 |
$12K |
| D1120 |
Prophylaxis - child |
540 |
523 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,515 |
1,824 |
$6K |
| D1206 |
Topical application of fluoride varnish |
478 |
460 |
$6K |
| D1351 |
Sealant - per tooth |
352 |
65 |
$6K |
| D7310 |
|
30 |
12 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
41 |
$2K |
| D0160 |
|
65 |
64 |
$2K |
| D9110 |
|
29 |
27 |
$1K |
| D4910 |
|
12 |
12 |
$460.00 |
| D0270 |
|
36 |
35 |
$154.56 |
| D0350 |
|
16 |
15 |
$0.00 |