| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,198 |
1,436 |
$697K |
| D5110 |
|
1,172 |
1,151 |
$654K |
| D7310 |
|
2,493 |
904 |
$447K |
| D0140 |
Limited oral evaluation - problem focused |
13,270 |
9,726 |
$365K |
| D5120 |
|
675 |
655 |
$364K |
| D7250 |
|
2,928 |
558 |
$286K |
| D2335 |
|
2,339 |
423 |
$245K |
| D9110 |
|
3,794 |
3,395 |
$229K |
| D4341 |
|
4,533 |
1,261 |
$162K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,475 |
3,451 |
$130K |
| D0330 |
Panoramic radiographic image |
3,025 |
2,997 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
760 |
297 |
$85K |
| D2332 |
|
362 |
141 |
$40K |
| D5212 |
|
68 |
66 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
783 |
213 |
$29K |
| D5410 |
|
1,243 |
1,085 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
292 |
157 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,074 |
2,006 |
$22K |
| D1206 |
Topical application of fluoride varnish |
727 |
718 |
$17K |
| D1110 |
Prophylaxis - adult |
276 |
276 |
$17K |
| D5411 |
|
722 |
629 |
$16K |
| D0274 |
Bitewings - four radiographic images |
974 |
965 |
$14K |
| D5211 |
|
41 |
39 |
$14K |
| D1999 |
|
1,043 |
796 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,808 |
1,112 |
$12K |
| D7311 |
|
48 |
25 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
24 |
$3K |
| D4910 |
|
12 |
12 |
$736.00 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$607.20 |