| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
5,960 |
5,575 |
$550K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,356 |
1,110 |
$421K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,961 |
1,514 |
$403K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,161 |
1,458 |
$333K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,291 |
922 |
$211K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,207 |
4,126 |
$161K |
| D0210 |
Intraoral - complete series of radiographic images |
2,548 |
2,466 |
$109K |
| D2335 |
|
588 |
351 |
$104K |
| D0411 |
|
2,100 |
2,011 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,774 |
2,699 |
$78K |
| D1110 |
Prophylaxis - adult |
1,645 |
1,601 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,287 |
2,232 |
$66K |
| D2394 |
|
313 |
245 |
$60K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
358 |
226 |
$53K |
| D5110 |
|
61 |
61 |
$48K |
| D2330 |
|
444 |
242 |
$44K |
| D2332 |
|
267 |
179 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,010 |
2,930 |
$37K |
| D0330 |
Panoramic radiographic image |
416 |
401 |
$21K |
| D2331 |
|
103 |
73 |
$13K |
| D5120 |
|
13 |
13 |
$10K |
| D4355 |
|
81 |
81 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
159 |
159 |
$4K |
| D1206 |
Topical application of fluoride varnish |
190 |
189 |
$3K |
| D1120 |
Prophylaxis - child |
48 |
48 |
$1K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$525.72 |