| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,475 |
1,100 |
$242K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,152 |
1,652 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,037 |
5,750 |
$152K |
| D0330 |
Panoramic radiographic image |
3,635 |
3,465 |
$136K |
| D0274 |
Bitewings - four radiographic images |
4,426 |
4,216 |
$100K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,561 |
862 |
$89K |
| D1110 |
Prophylaxis - adult |
2,301 |
2,184 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
973 |
223 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,861 |
1,083 |
$74K |
| D1120 |
Prophylaxis - child |
1,621 |
1,557 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
1,154 |
1,063 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,903 |
1,824 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
3,040 |
2,800 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
565 |
542 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,300 |
1,116 |
$9K |
| D5110 |
|
13 |
13 |
$9K |
| D1351 |
Sealant - per tooth |
431 |
117 |
$8K |
| D2394 |
|
69 |
49 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
35 |
29 |
$556.13 |
| D0431 |
|
145 |
139 |
$0.00 |
| D9986 |
|
84 |
73 |
$0.00 |